Singer Paula Cole asked “where have all the cowboys gone?”, disillusioned that things are not what they had seemed to be at first.
Where is my Marlboro man?
Where is his shiny gun?
Where is my lonely ranger?
Where have all the cowboys gone?
Yippee yo, yippee yeah
What do we value about cowboys? In part, it’s their self-sufficiency, their adventurous, independent spirit, cool swagger and the ability to shoot a gun to save the day. I grew up being told cowboys were the coolest. Again, my mom referred to herself as “the Puerto Rican cowgirl”. From an early age I wanted to be a psychologist partly due to Silence of the Lamb’s Clarice’s ability to kick some ass. She was the psychology cowgirl. But now, there are no cowboy movies and psychologists in the movies or TV are just as screwed up as their patients. Look at the show Hannibal. Along with the release of the DSM-V, there are other major changes that are occurring in the field of psychology both for the good and not so good. Yet many psychologists remain entrenched in their narrow, academic existence. There is a quiet paradigm shift underway, driven by a medicalized view of psychology that will likely have severe impacts on the field of psychology (and not for the better).
A while back, a psychologist lamented in a national psychology newsletter that consulting and industrial/organizational psychologists are often referred to as business and organizational consultants instead of being called psychologists and as a result many of them teaching in business schools rather than in psychology departments. As one of those ostensibly organizational psychologists that are out there, I can tell you that it is not so much that I do not call myself a psychologist (duh look at my WordPress handle), but it is that the field of psychology has often cast me aside. I am too applied and actually use my skill sets in the field as opposed to waxing philosophical and all theoretical about how stigma impacts interactions or “Simulating social dilemmas: Promoting cooperative behavior through imagined group discussion.”
There is cutting edge research out there on brain plasticity — the ability of the brain to renew itself — but those research articles are often found under the rubric of “neuroscience” and the psychology of it all takes a back seat. A recent study published online in the APA Journal of Applied Psychology (Hannah et al., 2013) linked adaptive leadership skills with brain functioning and psychological complexity measures among active leaders. Those leaders who were found to be more adaptable and complex in psychological studies appeared to have brains that function differently from those of less adaptable leaders. Seems with issues popping up in Afghanistan, Benghazi and the like this research could be of great benefit. Don’t get me started on the irony of how this leadership article in the Journal of Applied Psychology may be useful in the field yet similarly placed articles are not readily available for free to the public. If I wanted to read the article “Situation assessment as an ignored factor in the behavioral consistency paradigm underlying the validity of personnel selection procedures”, I would have to pay $11.95. Yet, how did they even get that research funded to begin with? I am sure those lead researchers got some government funds to do that research. Where is my taxpayer ROI (return on investment)?
In a recent meta-analysis, researchers found that when it comes to autonomy or wealth, that there is a strong statistical effect of individualism. Apparently, providing individuals with more autonomy appears to be important for reducing negative psychological symptoms, relatively independent of wealth. I am sure that this analysis took several years, several graduate student researchers and has probably led to a nice tenure track position (if not already produced by someone tenured). And for what? I think many of us on the front lines of communities who have boots on the ground kind of know that while money helps meet basic needs there is something about being free and autonomous that is really helpful to an overall sense of well-being and let’s not forget about safety as well. I mean isn’t this what Maslow posited way back when? Ok, at this point you may be wondering where I am going considering that I am psychologistmimi. Well, as a psychologist rooted in the community I can engage in a bit of critical analysis of the field.
This past week, there was a bombshell dropped in the field by NIMH (the National Institutes of Mental Health)–the big funder of psychology-related research. The big Sugar Daddy! See, next week the American Psychiatric Association is publishing its fifth take on the classification of psychiatric disorders, the DSM-5 (Diagnostics and Statistics Manual, 5th Edition). There have been many rumblings since December when we all got sneak peak of the various new components, classifications and revisions. At times, it seemed that the DSM was pathologizing normal behavior (sort of akin to how many pathologize the Hispanic male by using the term machismo to describe gender roles in Hispanic cultures that are very much similar to gender roles found throughout the world. But that’s a whole other rant). But back to the DSM-V. Not only does it seem to come up with a mental disease for every action but it also seemed to bend in the political wind of the moment. Yet, somewhat surprisingly, the NIMH after raising several concerns about the new DSM-V as well as general traditions in diagnosing mental health issues announced the NIMH will no longer be using DSM diagnoses in its research projects. Huh? What will this all mean?
Let’s step back. Particularly troubling to the NIMH is the fact that mental health diagnoses are based primarily upon symptoms, and that experts diagnose diseases based upon agreed-to symptoms rather than tests, such as blood work. This, argues the NIMH, makes the mental health diagnostic standards less valid than diagnostic standards in other areas of medicine. The ludicrousness of such a claim should be self-evident to anyone with any experience in today’s healthcare system. You go to the doctor, the y ask you your symptoms, they poke and prod you a little bit (very unlikely to do any actual biological tests), and write you a prescription. The change also could mean that the NIMH will be less likely to fund research that does not focus on biological psychiatry. With all we’ve learned about the social aspects of health, this is like turning back time. Treatment that focuses on altering a person’s environment while also treating his or her brain—for example, by encouraging meditation and the development of relationship skills in conjunction with antidepressants—might begin to fall by the wayside. As a social psychologist, I have been trained to think of behavior as the result of the person by the environment (B =P x E is our mantra). Where will that behavioral science equation go if funding goes solely by biological standards? Some might say this is the medicalization of mental health. Note that recent data has shown that 90% of pediatric specialists don’t follow guidelines for treating preschoolers with ADHD. What will happen now that there will be numerous guidelines from different entities?
One can also ask, where will all the psychologists go? Number one, psychologist cannot go quietly into the night. Psychologists are actually in many fields and positions. They should make their expertise known. Get their swagger on. Not only known, but also applicable to day to day life. It is a widely held belief that major health problems are not only biological in origin, but are also environmental (i.e. lifestyle, access to care, and psychosocial issues), yet less than 10% of the NIH funding goes to research in these areas. Psychologists need to become advocates and self-sufficient. Psychologists need to get more connected to communities so they can understand what research is really needed on the ground and how it can be effectively disseminated to have an impact. And academic psychologists need to stop sneering at those of us who are out on the front line of human psychology, dealing with the messy, hard-to-quantify reality that never gets you tenure, but serves our fellow human beings.
Psychologists need to tap into the heroic cowboy of yore and not go the route of the forgotten, no longer seen cowboy. Forget about cells, molecules and genes. Well, it’s kind of hard to forget about them completely, but perhaps if we started addressing social inequities, social determinants of health and health disparities we could get somewhere with mental health.