For the past several years, I have impassively watched with some interest, but with little sense of urgency, the campaign by psychologists to secure prescribing privileges for psychotropic medications in the military and in the various states. No longer incoate, their recent achievment of this goal in New Mexico now incites me, at the eleventh hour, to speak out for our patients in Minnesota.

To my knowledge, I am the only practicing psychiatrist in Minnesota who is also a licensed clinical psychologist. Both my psychiactric and my doctoral psychology training were acquired at the University of Minnesota. Hence, I would claim standing to speak knowledgeably about the disparate training under the two curricula. Both excellent, they are by no means coincident of comparable.

As a psychiatrist who had trained in large measure under Starke R. Hathaway, author of the Minnesota Multiphasic Personality Inventory (MMP), I recognized that there are many areas whithin the vast scope of human understanding that are necessarily given short shrift in the course of the psychiatry residency. (At the risk of offending my medical colleagues, I assert that psychiatrists receive, for example, precious little backgound training in individual differences, learning theory and psychometrics.)

It was likewise abundantly clear to me, as a psychiatrist but also as a psychologist-in-training, that psychology graduate students receive virtually no exposure to clinical neurology, psysiological chemestry or the psychological phenomanology of medical disease, except, perhaps on an elective basis. Speaking from a strictly medical perspective, psychology doctoral candidates are essentially well-informed laypersons.

While psychology and psychiatry may very well meet at the juncture of attempting to assess and lend succor to psychologically distressed persons, they derive this commorality from diverse traditions and training. One is neither superior nor inferior to the other; they are simply very different genres. Hence, it is no more fitting that a psychologist prescribe for psychotropic medications (even after a tailored, crash course in medicine) than it is for pasychiatrist to presume some ability to interpret an MMPI-2 profile by mere dint of having been psychiatrically trained in Minnesota.

We have all encountered that patient who assertively proffers an opinion - nay, makes a demand - for just what medications he believes he needs, and who would bypass the phsysician altogether if the law but permitted. In the U.S., nobody doubts that folly of laypersons self-prescribing. I submit that the psychologist who would write prescriptions (even upon satisfaction of minimal, statutorily defined requisites) would add very little incremental safety or clinical validity to such a contrivance.

I have long mused that a reasonably bright but medically naive person might learn how to craft prescriptions for psychoactive medications in a two-day workdhop (Envision, if you will, a two-column take-home hand-out in which the common mental symptoms listed in one column are matched with recommended medications and dosages in the other. Psychopatholigic diagnoses could be foregone altogether!)

Obviously, not even the legislative-minded would countenance such a reckless scheme. And yet, some of them would argue quite as fatuously that a superficial exposure to medicine and psychiatry might properly vault to a psychologist into that very power and authority.

The thinking of enabling legislators (as well as those who blandish them) seems to go little beyond simplistic formulation. They are apparently unable to look behind the paper prescription itself to appreciate the basic fund of medical and psychiatric knowledge, and the disciplined decision-making processes, that undergird the ultimate writing of that prescription. Nor would they seem daunted by the death of these attributes in those psychologists who would clamor for the Rx pad.

On this issue, I cast my lot with psychiatry. Unfortunately, psychiatry in every state, but in Minnesota expecially, faces an uphill battle. Our detractors look askance at our genuine concern for our patients, and dismissively characterize our protests as mere self-serving attempts to preserve power and turf.

And, while the executors of managed care in this state may declaim, righteous concern for the welfare of their "subscribers," particularly in underserved areas, these are the self-same persons who would effectively reduce psychiatrists to mere 15 minute scriveners of Prozac prescriptions, while delegating psychotherapy (once considered the quintessence of psychiatric intervention) to conselors and pychologists of stunningly modest credential, and experience. Surely these financially prepossessed executives will be more disposed to endorse than they will be to counter and help thwart the psychologists' legislative campaign.

I am quite as pleased and pround to be a clinical psychologist as I am to be a psychiatrist. Having been trained in both disciplines in Minnesota, I am cognizant of the universe of knowledge from which each draws. In the final analysis, psychologists are not quasi-physicians, and will not evolve as such after a few hundred hours of medical/psychiatric training. If a psychiatrist seeks to administer and interpret neuropsychological tests, let her become a psychologist and do so. If a psychologist seeks to practive psychopharmacology, let her become a psychician and psychiatrist.

A prescription uttered by a psychologist with inadequate medical training is indeed a prescription for disaster. Those legislators who would promulgate, enabling statutes, and those psychologist whose hubris would lead them to prescribe, are in league to play fast and loose with the welfare, indeed the very lives, of Minnesota citizens. This augers to be a very dangerous game of roulette in which the grievous losers will be our patients, and also the perceived integrity of the helping professions at large. The only conceivable winners will be the attorneys representing harmed patients of their estates.

Rodger C Kollmorgen, M.D., Ph.D., J.D., is the medical director of Unity Hospital Substance Abuse Services and also maintains a small forensic psychiatric/psychology practice. He is a member of the Minnesota Bar and consults to the Minnesota legal profession and bench. This article is adapted from a letter that appeared in the October 2002 issue of Ideas of Reference, the newsletter of the Minnesota Psychiatric Society.

Back to top

Feedback? Questions? Email me at db@itascapsych.com