The health-wealth gap

I would like to commend the Monitor for showcasing an article on the relationship between access to money and health outcomes ("The health-wealth gap," October). As a psychologist in private practice, a common theme I encounter is dysphoria related to these kinds of sociopolitical system dysfunctions. One example is young adults unable to leave dysfunctional living situations because of exorbitant rents, few and low-paying employment options, and costly tuition. Another is families suffering because of long, stressful commutes, often 60-plus work hours demanded and overtime often uncompensated, working for often narcissistic and sometimes sadistic supervisors, and the ever-present threat of losing the job. One intervention is to point out the dysfunction of the societal system and validate the normality of the client's distress given the maladaptive system.

I hope that the Monitor and research psychologists continue working and publishing regarding this critically important area of overall sociopolitical dysfunction that is creating so much human misery and often irreparable and lethal environmental and public health damage. In the Monitor article, Linda Gallo, PhD, is credited with making the point that "many entrenched U.S. policies are ... at odds with our well-being." Social scientists are well positioned to promote awareness of the various facets (such as selective bias toward sociopathic leadership, and toward enabling of this sociopathy by promotion of illogic, narcissism and paranoia) of sociopolitical systems that critically endanger us all.

Barbara A. Kidney, PhD
Newburgh, N.Y.

"The health-wealth gap" provides many recommendations to address the problems of longevity of all Americans from a collective perspective. However, it overlooks a fundamental one, increasing personal accountability for achieving and sustaining physical health and wellness. Despite the government's implementation of health promotion and prevention initiatives and generating increased awareness of public health issues, Americans continue to experience high rates of obesity, diabetes and other chronic illnesses. Although various obstacles may impede individuals from engaging and maintaining participation in these programs, alternative avenues need to be pursued.

Based on my professional experience in working with adults with a range of medical problems, and on research I have conducted on exercise and psychological well-being, there does not seem to be a clear-cut answer on how to motivate individuals to take personal responsibility for making healthy lifestyle choices. Yet what is evident are a need and an opportunity for research and intervention in this area for psychologists. As the article indicates, chronic stress and unhealthy decisions made by individuals exacerbate health problems and mortality rates. Therefore, as psychologists expand their role in primary care, hospitals, school systems and other community institutions, they are in an ideal position to address the relationship between psychological stressors and physical well-being of individuals and communities. Hopefully, future research and practitioners will be able to guide people to make their health and their family's health a priority and ultimately increase the overall well-being of Americans.

Lisa Smith, PsyD
Sacred Heart University

Does anyone with conservative views work for the Monitor? Your article on the "health-wealth gap" must have taken a page from the Obama book of redistribution of wealth … aka, socialism. These liberal policies do not work, period, but folks keep writing about them because it would be too much of a challenge to actually research the topic and present a more balanced view.

As a psychologist who works for a living and thinks others should as well, I am tired of the usual fare the Monitor continues to dish out. I am embarrassed for our profession when you can't present research without pushing your agenda, and the research does not support your liberal philosophies. Tell me of one successful socialist country. If your magazine is going to offer opinion, then present the other, more rational, side as well. Thank you for listening.

Frederick Neff, PsyD
Beverly, Mass.

Thanks for remembering

I just read the October Monitor article on the Minnesota Semi-Starvation Experiment by Dr. David Baker and Natacha Keramidas. It is the most coherent and factual article I have ever read on the subject.

My husband, Robert Villwock, was one of the 36 men who participated in that experiment. His weight went from 136 to 105 pounds. He is no longer living, but I know he would be very pleased to know that the experiment is remembered and relevant. It was a very hard assignment even during the periods of adequate calories. How could we go for an entire year without taking one spoonful of food that hadn't been weighed and measured?

For me, one of the most interesting findings was that about apathy. Every one of the 36 men had probably been leaders of their social groups. But at the apex of the experiment, all were hit by such feelings of apathy that their leadership abilities went way down. And yet we wonder why more leaders don't arise out of poverty areas and organize people for a better life. We ask, where are their leaders? Their leaders are starving.

My husband felt honored to have been part of the Minnesota experiment. The dedication of those men cannot be overstated. Thank you for remembering.

Dorothy Villwock
White Bear Lake, Minn.

The death penalty

Though I agree that the death penalty is controversial, I must take our president to task in his assertion in his October Monitor column that free will is a "legal fiction" that is "impervious to the principles of science." First, psychological science is science. As psychologists, we capture ineffable ideas, tame them and make them measurable so that we can know what is and is not verifiable. Self-esteem, perfectionism, depression, extroversion, catastrophic thinking …. We find these profoundly interesting ideas to be worthy of study, so we work hard to validate them as measurable constructs. Our theoretical models get honed and revised, tested and revised again. Then we make scientific predictions about behavior and revise again. In that way, we are closer to theoretical physics than to biology. Perhaps "free will" is one of many Higgs boson particles in our domain of study, but to say that it is a fiction is to discount the very nature of our work.

Second, biological determinism is certainly a core element that shapes behavior. Yet our cultural history points again and again to the idea that somehow humans are more culpable for their behavior than other animals. The culpability does not lie solely with society and its failures to properly "train" our humans. That line of thinking is reserved for circus performers whose animals get loose and wreak havoc on the audience. The core difference between humans and other animals lies heavily in the domain of "free will." Conscience, intention, meta-cognition, self-control … whatever you call it, humans do have a degree of separation between their conditioned behavioral tendencies and their actual choice. We are the only creature that can march forward in a war with our knees shaking in fear. We are the only creature that can turn our back and walk away from a fight, seething with anger at the injustice that was done.

A call to abolish the death penalty? That is a question that can be argued intelligently and civilly among individuals with diverse opinions. But let's use psychological science to forward an agenda of knowing what it is that we are talking about.

Maureen D. Rickman, PhD
Madison, Wis.

I am writing to thank you for Dr. Donald Bersoff's position paper on the death penalty in the October Monitor. I have long believed that the death penalty should be opposed by everyone, but especially by people who claim to work to further human welfare.

Freda B. Stone, PhD
Evansville, Ind.

Accredited internships

In the article "Action by APA's council supports quality education" Dr. Cynthia Belar reported on the APA council's resolution calling for all future health-service psychologists to be, among other things, trained in accredited internships as a requirement for licensure. Dr. Belar expressed the opinion that "the resolution will not affect students currently in the pipeline or those currently licensed."

I respectfully disagree with her. Psychologists who didn't have accredited internships will eventually see their licensure mobility dry up if states require them for licensure. What if years down the road a psychologist needs to move to a new state but can't get licensed there because they no longer allow people with unaccredited internships to get licensed? Any grandfathering provision would need to preserve our licensure mobility for decades in order for it to "not affect" us.

This resolution stigmatizes us and could affect us by making it harder for us to get a job, pay our loans and feed our families. This resolution affects our ability to advocate with employers who currently hire only psychologists with accredited internships. More employers may follow the mistake of the Department of Veterans Affairs and require accredited internships even to apply for a job. This resolution affects us by making it harder for us to defend ourselves against non-evidenced based employment selection practices. It also affects us by making it appear that our professional association doesn't respect us, won't defend us and won't advocate for us with the largest employer of psychologists in America.

Todd Finnerty, PsyD
Columbus, Ohio

APA's response:

APA supports grandfathering. APA policy states that to practice as an independent health service psychologist, candidates must graduate from an APA/Canadian Psychological Association accredited doctoral program and internship or programs accredited by an accrediting body that is recognized by the U.S. Secretary of Education for the accreditation of education and training programs that prepare students for entry into professional practice. The resolution gives unaccredited graduate programs five years to become accredited and seven years for internship programs to gain accreditation. This policy will not impact students currently in the pipeline and allows for grandparenting of those graduates from unaccredited programs who are now licensed providers.


A September letter on page 6 by M. Duncan Stanton, PhD, left out that significant others can also be instrumental in getting adolescent substance abusers to enter treatment or self-help. The letter should have also noted that the 113 family-couple randomized controlled trial total mentioned included studies not only with adult, but also with adolescent substance abusers.

Please send letters to Sara Martin, Monitor editor. Letters should be no more than 250 words and may be edited for space and clarity.