Controversial Issues Exam 2 Study Guide

+Controversial Issues Exam 3 Study Guide

Should Animals Be Used in Psychological Research? Baldwin (yes) vs. Bowd and Shapiro (no)

Human use of animals - Baldwin supports her position by saying that fewer animals are used for research than for other human use such as for food.

"Antivivisection" Movement - A late 19th century movement in Great Brittan that essentially argued against the use of animals for research. The modern animal rights movement can be traced back to it.

"Animal Welfare" - Is different than "animal rights" according to Baldwin. This refers to improving conditions for those animals that are used in research and helping reduce the numbers of animals used in research. the "Utilitarian Argument" - According to rights activist Peter Singer, animals have as much right as humans to not be subjected to pain and suffering. It follows that they should not be used in experiments.

Edward Taub and the Silver Springs Monkeys - An often cited case of animal abuse in which the monkey subjects were treated inhumanely. Though there was a strong initial reaction, there were really minimal consequences for Taub.

PETA (People for the Ethical Treatment of Animals) A large well funded, and controversial, "animal rights" organization with many famous supporters. They appeal to animal lovers for funds but some say, PETA members are fanatical and that financial irregularities exist.

"Animal Welfare ACT" - Was set in place to protect research animals. According to Bowd and Shapiro (against animal research), due to a "loophole" in the system, as many as 90% of animals (species) used in resaerch are not covered under the act and are, therefore, not included in federally mandated inspections.

Is Love a Mechanism of Evolution? Fisher (it is) vs. Reber and Beyers (it's not) Limerance - Dorothy Tennov's unique term for "being in love."

Love and neurobiology - Michael Liebowitz claims to have identified biochemical correlates of various stages of the human mating process as follows: Stage 1 - amphetamine-like PEA and monoamine (e.g., dopamine) neurotransmitters Stage 2 - endorphins

Does love last? - Tennov and Money suggest that, on average, humans will "be in love" between eighteen months and three years.

Serial Monogamy - Mating pattern proposed by Helen Fisher in which humans mate, bear one or more children, and after about four years separate and repeat the process. This would support love as being a mechanism of evolution). Reber and Byers (not evolution) argue that current divorce rates do NOT support this theory.

Mating desirability - Though not in the article, a large body of research shows that people unconsciously are attracted to specific traits in potential mates: 1. symmetrical facial features, clear skin, and straight teeth 2. wide hips in females 3. a triangular (wider at the chest) torso in males

Love and Biology (chicken and egg?) - Fisher says biology produces love. Reber and Byers suggest that love produces the biological sensations that accompany it.

Should Psychologists Be Allowed to Prescribe Drugs? DeLeon and Wiggins (yes) vs. Hayes and Heiby (no)

Who can prescribe psychotropic meds.? - Currently, most anyone with an M.D., psychiatrists, family doctors, and OBGYNs. According to DeLeon and Wiggins, "general practitioners" now prescribe more psychoactive drugs than any other group of professionals.

Why Psychologists? - DeLeon and Wiggins argue that psychologists, who have had years of training in psychopathology, could do a much better job than general practitioners. One stop mental health care - DeLeon and Wiggins point out, and Dr R agrees, that the extra time and expense of having to see both a therapist and a separate prescriber could be eliminated if psychologists could prescribe. This would much more efficient and cost effective.

Position of the American Psychiatric Association - is that psychologists should NOT prescribe. Many arguments (e.g., lack of biological knowledge) are made but the real underlying reason is likely competition and the potential reduction in the earnings of psychiatrists.

Hayes and Heiby's opposition - These psychologists feel that psychologists should stay with their traditional methods. Prescription privileges would be detrimental to psycholology's identity.

Benefits of prescribing privileges - Those in support cite the following potential benefits. 1. It would stop the psychologist's over-reliance on psychotherapy. 2. It would solve the problem of an "oversupply" of practicing psychologists. 3. It would differentiate doctoral level psychologists from master's-level providers, and perhaps, make them more attractive to managed care.

Algorithms and Computer Technology - DeLeon and Wiggins (for prescribing) suggest that these make privileges for psychologists more feasible (as less knowledge would be required). This could actually work against their case. Computer algorithms have actually been shown superior to clinical judgment in diagnosing, according to some.

Success stories - DeLeon and Wiggins cite the following successes in support of prescribing priviliges: 1. non-psychiatrists have been "functionally prescribing" for years in the Veteran's Administration 2. non-psychiatrists have been "functionally prescribing" for years in rural America where psychiatrists are in short supply 3. non-psychiatrists have successfully prescribed in the California "Prescribing and Dispensing Pilot Projects"

General Practitioners - According to Deleon and Wiggins, currently prescribe more psychoactive drugs (esp. antidepressants) than any other group of professionals. They think psychologists have more and better training in mental disorders and could do a better job.

Is Pornography Harmful? Russell (yes) vs. Strossen (no) Russell cites three ways in which pornography increases the probability of rape: (1) pornography predisposes and/or intensifies men's predisposition to want to rape women, (2) pornography undermines males' "internal inhibitions" against rape, (3) pornography undermines males' "social inhibitions" against rape.

Classical conditioning – Stanley Rachman demonstrated that men could learn to become sexually aroused to an object (a woman’s boot) after repeatedly seeing them paired with pictures of nude females.

"Masturbatory" (operant) conditioning - McGuire, Carlisle, and Young's term for an operant conditioning process that may occur. Dianna Russell suggests that sexual self- satisfaction following a pornographic movie may strengthen the association between rape (if depicted) and sexual gratification.

Magazines too - Dianna Russell cites the case of a woman who testified before the 1986 Attorney General's Commission on Pornography, that her son died of autoerotic asphyxia after reading the article "Orgasm of Death" which was published in Hustler magazine.

The 1984 Dolf Zillman and Jennings Bryant research - Cited by Russell, this study involved "massive/prolonged" exposure to non-violent pornography. It was found that with massive exposure to pornography, viewing preferences moved from more common milder to less common more intense forms of pornography, including some degree of pseudo-violence or violence.

The Donnerstein and Linz Study – showed R and X rated movies to male subjects. After 10 hours of exposure, the subjects 1. rated rape victims as more worthless, 2. rated the attack / injury as less severe, and 3. put more blame on the rape victims when compared with controls.

Validity Issues - Dr. R points out that in experiments such as Zillman and Bryant's and Donnerstein / Linz, confounds, demand characteristics and methodological problems may make the findings questionable. In other words, the studies may be lacking in external validity.

Prohibition analogy - To argue that censorship won't work, Nadine Strossen points to the failure of the federal government's attempt to ban alcohol "prohibition," in the 1920s and 30s.

Marcia Pally’s book, Sex and Sensibility (cited by Strossen) – Reviewed the lab experimental literature and concluded that there is no evidence that exposure to explicit sexual materials “causes” any sexist or violent behavior.

Correlational data - Russell provides data that she says supports her argument. Strossen argues that correlational data cannot be used to infer causation. She says Russell's data could be explained by pornography being correlated with other demographic variables such as a high percentage of young males in the population and cultural traditions that support a highly masculine or "macho" male identity.

John Money of Johns Hopkins - suggests that the childhood histories of sex offenders are often characterized by repression and strict anti-sexual attitudes. If this is true, Strossen argues, censorship won't work.

Where the problem really is - Strossen argues that, in Western society, it is the mainstream popular media (TV, movies, music, art, literature, etc.) and not "pornography" that provides the bulk of sexually explicit material and shapes sexual identities.

The “Forbidden Fruit Effect” – Strossen also suggests that when something is denied (as in banned) people will want it more (as with prohibition or Madonna’s controversial book of explicit photos).

Should Mental Health Professionals Serve as Gatekeepers for Physician-Assisted Suicide? Farberman (yes they should) vs. Sullivan, Ganzini and Youngner (no they shouldn't)

Jack Kevorkian - AKA "doctor death," has been the most prominent figure in the assisted suicide debate. He has spent time in jail for defying court rulings. Some see him as a compassionate man who helps end suffering. Others think he has a morbid pre-occupation with death.

Position of the Supreme Court – In 1997 the court ruled that terminally ill patients do NOT have the right to physician-assisted suicide but did give the states the right to enact their own statutes on this issue.

Position of the APA on assisted suicide - the APA does not advocate for or against assisted suicide, it sees the role of psychologists as one of providing support and information. Are they taking the easy way out?

Depressed, how do you know? - Farberman suggests that determining if the person is clinically depressed is an important factor in this critical decision. However, according to Dr R., this is problematic because such a conclusion would rest on "circular reasoning" or "reification." In other words, The person want to die. Therefore, he or she must be depressed. How do we know he or she is depressed? Because he or she wants to die!

A mandated waiting period - Sullivan, Ganzini, and Youngner point out one "safeguard" for those requesting assisted suicide which was implemented by the state of Oregon: a delay of 15 days. This would allow some time to see if the person has a change of heart. Dr. R thinks it's a good idea.

Views on Suicide: 1. A crime – At one time, but not now, it was seen as a crime not just against oneself but against society. 2. Culture and religion - Have always provided guidelines on this topic. For example, the Catholic Church and Orthodox Judaism are adamantly opposed to suicide, assisted or otherwise. 3. The “medical model” – Assumes that if one is considering suicide, he or she is NOT rational.

Requiring a psychiatric examination - Sullivan, Ganzini, and Youngner point out that mandating a psychiatric examination is problematic because to do so implies a priori (before the fact) that the person is, in fact, not psychiatrically competent. Some would say, and I won’t disagree, that suicide based on severe and unrelenting psychological pain (which is not always depression) may well be as rational a choice as in the case of physical pain.

Is taking one's own life a right? Is it OK in the case of physical but not psychiatric pain? Is it OK for old people but not for young people? At what age does an individual have the right to make this decision? These are all difficult issues.

Is Electroconvulsive Therapy Ethical? Fink (yes) vs. Frank (no) Primary use of ECT - ECT is most often used in cases of very severe depression after other less extreme treatments have failed.

Types of ECT - Max Fink (favors ECT) discusses various types of ECT (e.g., unilateral vs. bilateral and square vs. sine wave current) and how the procedure has changed over the years. The type of ECT favored at present is bilateral with a brief pulse square wave current.

Why use ECT - Max Fink's makes several arguments (safety, efficacy, cost, etc.) for increased use of ECT. His greatest effort seems to be on convincing the reader that modern technology has made ECT safer and more effective than most people think it is.

Leonard Frank - (against ECT) describes his own experience with psychiatric treatment. His experience with ECT was very negative. In addition to ECT he was also treated with a series of fifty insulin coma treatments

A Historical Case - Leonard Frank ends his article with an effective and moving description of the treatment and subsequent suicide of a famous individual. Ernest Hemmingway, the famous writer, came from a family with an extensive history of depression and suicide. He described his treatment as having taken away his ability to do what he did best. After his release, he committed suicide.

Efficacy of ECT over time - Regarding how long the effects of ECT last, Leonard Frank (opposes ECT) suggests, based on a review of research by Weiner (1984) that the beneficial effects of ECT last no longer than four weeks. Proponents such as Fink, of course, argue that it is longer than that. The Brain Disabling Hypothesis - Regarding the effects of ECT, Leonard Frank cites Breggin (1979, 1981) who states that ECT causes amnesia, denial, euphoria, apathy, mood swings, helplessness, and submissiveness which psychiatrists perceive as positive changes.

ECT and Legislation - Changes in the law come about slowly. The Committee for Truth in Psychiatry support the Food and Drug Administration's original categorization of ECT machines as "Class III" (high risk) devices. The American Psychiatric Association wanted the FDA to re-classify the devices as "Class II" (low risk). The current status of this situation is that the FDA, after much indecision, proposed, in 1990, to reclassify the machines but has not yet done so.

The demographics of ECT use. Frank points out that: 1. more than 2/3 of ECT patients are women (the same could probably be said for antidepressant use and psychotherapy). 2. an increasing number of elderly patients are receiving ECT (this may be because they have a harder time than young people handling the side effects of antidepressants).

Has Too Much Emphasis Been Placed on Empirically Supported Therapies? Garfield (yes, too much has) vs. Kendall (no, the emphasis placed on empirically supported therapies is appropriate and correct) “Disease Oriented Approach” – Garfield cites this current approach to mental health, apparent in the DSM-IV (APA), as contributing to the push for validated and specified treatments.

Influence of and pressure from insurance companies and managed care providers - In his introduction, Sol L. Garfield make it clear that these forces have played an important, and perhaps inappropriate, role in the "empirical validation" movement.

Garfield on the Task Force findings and conclusions – They are premature and too strongly stated.

Empirically supported therapies - is the term the 1995 APA Task Force finally settled on to refer to therapies that APA stood behind. According to Phillip C. Kendall, theTask Force spent a lot of time playing around with how to word things. Maybe too much time?

Concerns expressed by Sol L. Garfield - He cites three specific concerns regarding the influence of the APA's 1995 Division of Clinical Psychology Task Force Report: 1. that there will be a premature attempt to certify and mandate only certain approved therapies. 2. that every therapy will be linked to a particular diagnosis. 3. that accreditation of graduate training programs will become contingent on their teaching of approved therapies.

The prevailing view in mental health care - Given what we know about this, we are not surprised when Sol L. Garfield points out that most of the empirically supported/validated therapies reported by the APA 1995 Task Force come from the cognitive-behavioral perspective. Dr. R thinks this cognitive-behavioral bias is NOT warranted based on the existing research (and problems we discussed with much of that research).

Important factors being ignored – Factors such as therapist ability, patient involvement, the therapeutic alliance, etc. which Garfield (and Richman) think are very important are being downplayed as unimportant by the APA. Garfield cites several examples that support these “non-technique” factors such as the Sheffield Psychotherapy Project (second).

The Smith, Glass, and Miller Meta Analysis - Has been criticized and being invalid by Kendall. Sol L. Garfield refuses to accept that the Smith, Glass, and Miller Meta Analysis (1980) should be disregarded because of Kendall's claim that the studies analyzed pre-dated DSM-III and "training manuals" were not used in the studies. Kendall's real hang up may be that Smith et al. reported (as did the Consumer Reports Survey) that success rates were pretty much the same regardless of the type of therapy used.

The "Main Ingredients" in psychotherapy - Garfield cites Castonguay et al. (1996) who found that therapeutic alliance AND emotional involvement were associated with positive treatment outcome whereas use of specific modalities such as focus on distorted cognitions was NOT.

Eclecticism – Using a variety of theoretical approaches (whatever works). This was once scorned in psychological training but is becoming more accepted, even as the APA is wanting to impose more rigid and restrictive guidelines.

"Allegiance Effects" - Are mentioned by Phillip C. Kendall, though their existence argues against his position. He may have felt that he had to address the topic. This term refers to the fact that findings from treatment outcome studies usually seem to favor the treatment supported or believed in by those conducting the study.

Clinical vs. statistical significance – Actually pointed out by Kendall, and doesn’t support his position. A positive outcome study does NOT mean that everyone one was helped. More importantly, the “effect size” though significant, may not be large enough to be really helpful.

Philosophy or Psychic readers? – Kendall worries that without empirical support, psychology would be equated with these. I don’t think we are experiencing any shortage of outcome studies at present (quality is another issue).

Kendall’s response to Garfield – He says Garfield is unnecessarily concerned, that the APA is NOT trying to mandate specific treatments for specific disorders.

Supported/validated therapies vs. Manualized therapies - Both of these are important topics. Sol L. Garfield and Phillip C. Kendall both make the error of failing to clearly distinguish between them in their discussions.

Is Ritalin Over-Prescribed? Breggin (it is) vs. Barkley (it isn't) Peter Breggin (it is overprescribed) points out that, at the time the article was written, more than 2,000,000 children had been prescribed the stimulant drug Ritalin.

The Breggin article made several points about how the Food and Drug Administration (FDA) approves new medications: 1. a new drug may be approved for adults but not necessarily for children 2. a new drug may be approved for treating one disorder but not another 3. many practicing MDs, prescribe adult approved drugs for children even though the drugs have NOT been FDA approved for use with children. The DSM-IV recognizes two (really three) "forms" of ADHD: 1. hyperactivity-impulsivity 2. inattention 3. mixed The war against children – Is a book written by Breggin. It arose out of concerns over proposed federal research which would try to find “biological markers” for violence among inner city children. Positive findings would have provided a rationale for treating these children with drugs.

Bad or Mentally Ill – Breggin feels that health professionals want to explain ADHD as the result of “crossed wires” or “biochemical imbalances” in the brain. Thus, they are mentally ill and not responsible. He thinks that is would be better for children to see themselves as maybe a little “bad” as opposed to “mentally ill.”

Toxic Psychiatry – Is another book written by Peter Breggin. Taken together with "The War Against Children," it seems clear that Breggin is likely critical of psychoactive drugs and prescribing practices in general.

The U. S. vs. other countries - According to Peter Breggin, in Great Britain, Sweden, and Denmark, rates of ADHD are very much lower than in the US

“Build a better mouse trap and the world will beat a path to your door” – This old saying is applied by Russell Barkley to explain why medicating children with stimulants has increased dramatically over the past 20 years. He suggests that such a rapid increase is to be expected when a new and effective treatment is discovered (similar to the Prozac phenomenon).

Gender differences - Russell Barkley point out that boys with ADHD outnumber girls with ADHD 3 to 1. This may, to some extent, be a reflection of normal boy – girl behavioral differences and gender identities.

Problems for young adults - Russell Barkley points out that, when compared with young adults who do NOT have ADHD, young adults with ADHD: 1. have three times as many auto accidents 2. have four times as many speeding tickets An ADHD gene? – Barkley suggests the possible existence of a few or even a single “ADHD gene.” Dr. Richman disagrees because it is very doubtful that complex human phenomena such as psychological disorders, addiction proneness, sexual orientation, etc. are the result of one or only a few genes.

Genetics and ADHD - Russell Barkley attributes about eighty percent of the variability in who gets ADHD to genetics/heredity and only about twenty percent to environmental causes. He likely takes this very genetic / biological position to support the use of medications for the disorder’s treatment.

Normal trait or Pathology – In most cases (excluding organic anomalies, in utero damage, etc.) most cases of ADHD represent just being at the high end of a distractibility – non-distractibility continuum.

Are Prozac and Similar Antidepressants Safe and Effective? Appleton (yes they are) vs. Glenmullen (no, they aren't) Halgin 2 nd ed.

Prozac, the first SSRI - 1987 (late 1980s) marks the beginning of the SSRI era. Prozac was released and was touted as a wonder drug not only for treating depression but other disorders such as OCD as well.

Drug development is slow – Appleton points out that this is the case for two reasons. 1. The human brain contains about 10 billion cells and 50 known neurotransmitters making this a complex and difficult process. 2. A gradual process of careful testing is required before the Food and Drug Administration (FDA) approves a new drug for release (15 years in the case of Prozac). However, this process seems to be getting a lot less rigorous than it was 20+ years ago when Prozac was released.

Appleton (in support of SSRIs) points out a number of benefits the SSRIs have over the “older antidepressants” (MAOIs and Tricyclics). These include: 1. only one or two doses a day are needed. 2. a lower potential for being “lethal.” 3. they have fewer side effects. William S. Appleton suggests that the SSRIs do more than just lower depression. Additional advantages include: 1. decreased sensitivity to negative social interaction or rejection 2. activating the brain's pleasure center which may be deficient in depressed patients 3. decreasing the frequency and / or intensity of anger or rage 4. increasing the person’s sense of hope.

Appleton on SSRI side effects – He seems to suggest that many of the problematic ones go away with time. He suggests that some of the other side effects are due to the disorder not the medication.

Prozac vs. the other SSRIs – Appleton does NOT think Prozac is qualitatively different from the other SSRIs (Zoloft, Paxil, etc.). It was just there first and was featured on a the cover of Newsweek magazine.

Glenmullen on side effects – In contrast to Appleton, is quite concerned. He cites: 1. neurological problems including Parkinson like tics 2. brain damage 3. withdrawal when the drug is stopped 4. sexual side effects in 60 % of users 5. dependence 6. possibility of suicidal or violent behavior

Chemical Lobotomy – Glenmullen suggests that these drugs may actually irreparably damage (kill) the neuron terminals they target.

Antidepressants and money - Joseph Glenmullen described how his patient, Anne, experienced “withdrawal” after having to abruptly stop taking Zoloft. She stopped taking it because she no longer had employee medical insurance and could not afford to pay for the drug on her own. What Anne though was the return of her symptoms, Glenmullen was sure were signs of withdrawal (esp. the dizziness).

The “dread side effect in psychiatry” – Glenmullen uses this term to refer to “tics” and other motor disturbances. These are irreversible and are more commonly associated with the dopamine blocking (anti schizophrenia) drugs. Overprescribing – Glenmullen suggests that as many of 75% of those taking SSRIs are doing so for mild or even trivial reasons. He cites Pies of Harvard and Tufts who says these drugs should NOT be prescribed for the worried well or mildly depressed.

The 10, 20, 30, year pattern – According to Glenmullen, it will take 30 years or more for a problematic drug to be taken off the market because: 1. it will take about 10 years for the problems to be noticed. 2. 20 will go by before the data on the issue is irrefutable. 3. it will take another 10 years for professional and regulatory agencies to finally take firm action.

The rise and fall of “cosmetic pharmacology” – Glenmullen points out how Peter Kramer coined the term in “Listening to Prozac.” Some years later the idea was likened to science fiction in the New York Times Book Review.

“Prozac Backlash” – Glenmullen’s term for the idea that SSRIs do NOT return serotonin levels to normal but instead push them up to pathologially HIGH levels. When this happens, “compensatory reactions” occur in the brain, such as altered levels of other neurotransmitters such as dopamine (as occurs in schizophrenia).

The government’s role – Glenmullen accuses the federal government of devoting far too little time, money, and other resources to studying the long term effects of these drugs. As a consequence, we have an unwarranted “illusion of safety.”

Lobbying by drug companies - Glenmullen cites the 1998 book “Prescription for Disaster” by Thomas Moore. Moore points out that drug company lobbyists exert tremendous pressure on Congress to weaken laws relating to testing of new drugs and monitoring of side effects and other problems.

“Antidepressant discontinuation syndrome” – Accordion to Glenmullen, Eli Lilly (Prozac) funded work to develop this “euphemistic” phrase for withdrawal.

Overstated – Maybe a bit. Glenmullen thinks future generations may look back on the SSRI era as a “frightening human experiment.”