For those who don't know, Oregon's Governor Kulongoski vetoed the psychology prescribing bill. I found this unfortunate, not because I'm particularly keen on psychologists prescribing, but because I think the bill would have put needed pressure on my profession to take a closer look at what psychiatrists are and where we should be headed.
In his veto letter, the Governor said he was concerned that the Oregon legislature approved the bill in a hurried fashion during a Special Session which included no public input. He proposed that the legislature come up with a pilot program in 2011 to help to gather more information about how to solve Oregon's crisis of access to mental health treatment. What this means is that in all likelihood we will again be treated to the spectable of America's new blood sport--the vicious turf wars between psychiatrists and psychologists. American Gladiator pales in comparison.
Truly, these last few weeks have not been pretty, and I'll plead guilty to my part in the fracas. I was the first "prominent" psychiatrist to publically proclaim that psychologists with extra medical training might actually be able to prescribe some medications safely.
In doing so, I felt a bit like Salman Rushdie, whose 1988 book, Satanic Verses, so unnerved the Islamic orthodoxy that the Ayatollah Khomeini issued Rushdie a fatwa (a death sentence). My own version of "Satanic Verses" is called Unhinged: The Trouble with Psychiatry (Simon and Schuster, due out May 18, but who's counting?). The book is not about psychologists prescribing, but rather about the loss of psychotherapy from psychiatry. Nonetheless, it will likely enrage more than a few psychiatric jihadists, because in the last chapter I outline my prescription for reform, and it involves a fairly radical restructuring of psychiatric training. In this scheme, psychiatrists will be more competent than they are now, but they will unfortunately lose two crucial letters after their names: an "M" and a "D." I anticipate some resistance.
In the meantime, we are in a preposterous situation in which the two major organizations with expertise on the American mind are locked in mortal combat: the A.P.A. (psychiatric) vs. the A.P.A. (psychological). If they can't figure out how to resolve differences, God help us all.