The InterPsych Newsletter 2(5)



IPN 2(5) Section C: InterPsych Update 2/2


                 SECTION C: INTERPSYCH UPDATE (2/2)


      | As a way of recognizing their volunteer efforts  |
      | for InterPsych as well as their academic status, |
      | this section is to inform InterPsych members of  |
      | some of the recently published writing by IP     |
      | forum leaders, members of the board of directors |
      | and strategic planning group, and other IP staff.|       
      |                                                  |
      | Matt Merkley ( is the editor |
      | of the section.                                  |
      |                                                  |
      |   The citations are based on a search of new     |
      |   additions to the databases at the National     |
      |     Library of Medicine in Washington D.C.       |

a.   Klein DF; Wender PH
Understanding depression [letter]
Am J Psychiatry 1995 Apr;152(4):652
Unique Identifier: SDILINE 95208943

LETTER (Publ. Type)

b.   Stinson CH; Milbrath C; Horowitz MJ
Dysfluency and topic orientation in bereaved individuals: 
bridging individual and group studies.
Langley Porter Institute, University of California, 
San Francisco 94143.
J Consult Clin Psychol 1995 Feb;63(1):37-45
Unique Identifier: SDILINE 95204679


c.   Corballis MC
Can commissurotomized subjects compare digits between the 
visual fields?
Department of Psychology, University of Auckland, New Zealand.
Neuropsychologia 1994 Dec;32(12):1475-86
Unique Identifier: SDILINE 95191787


d.   Klein DF
Cognitive therapy [letter]
Br J Psychiatry 1994 Dec;165(6):838
Unique Identifier: SDILINE 95187591

LETTER (Publ. Type)

e.   Mannuzza S; Schneier FR; Chapman TF; Liebowitz MR; Klein
     DF; and others
Generalized social phobia. Reliability and validity.
Department of Psychiatry, Columbia University, College of 
Physicians and Surgeons, New York, NY.
Arch Gen Psychiatry 1995 Mar;52(3):230-7
Unique Identifier: SDILINE 95177721


f.   Galatzer-Levy RM
Children, bad happenings, and meanings [editorial]
J Am Psychoanal Assoc 1994;42(4):997-1000
Unique Identifier: SDILINE 95173308

EDITORIAL (Publ. Type)

     | This section contains some of the eloquent, timely, | 
     | or particularly informative messages from recent    |
     | discussions on InterPsych's forums. These selections|
     | were either chosen by the editor of this section or |
     | sent to the IPN mailbox. Our hope is that these     |
     | messages will offer a snapshot of the enthusiasm    |
     | and activity of InterPsych's many members.          |
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     | Reproduced postings are subject to possible         |
     | distortion by complicated mail headers or other     |
     | technical hardships. While effort has been made     |
     | to keep messages in their original form, they       |
     | have been reformatted to comply with the IPN's      |
     | line length. Neither InterPsych nor the InterPsych  |
     | Newsletter staff can be held liable regarding the   |
     | selection, use, content, and redistribution of this |
     | section. Sole responsibility rests with Matthew     |
     | Merkley (, the editor of this   |
     | section.                                            |
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     | If you have seen a posting that falls into this     |
     | category and deserves another look by the larger    |
     | InterPsych community, please forward it to the IPN  |
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     | to this effect in the body of the message.          |

Source-Date: Mon, 1 May 1995 22:41:55 -0400
Subject:  Re: Trend Toward Significance
=============================================================== says:
Anyone want to explain why most authors & editors of journals
consider p(0.05 to be significant, yet many papers never even
report the power? Many studies have very low power (0.5), yet
are still considered to have conclusions that we should base
our clinical decisions on.

Why not equalize both types of errors?

On p(.000001 not being definitive proof of a fact:  I agree
that it is not definitive proof, however, it certainly tells
you which side to bet on :-)

in the trade off between seeing something significant where
there is nothing  vs. seeing nothing significant where there
is something (or as a cynical statistician friend puts it-the
difference between love and apathy) most feel that sins of
comission are of more concern than sins of omission.

i think it depends on whether you are working in the context
of discovery to be followed by replication where i would
accept more type1 error and less type 2 or working in the
context of verification where the opposite holds.
don klein

Source-Date: Tue, 2 May 1995 23:55:35 +0000
Subject:  Feedback and thanks re: Consult

     I posted last Thursday about my concerns re: 60 year old
woman with  anxious and depressive symptoms, on multiple meds
for rheumatoid  arthritis.

     Within 12 hours I had several helpful notes; within two
days I  had received the most comprehensive consultative
assistance I could  have hoped for.  

     The woman is currently psych hospitalized for
stabilization.   She is under the care of a different
psychiatrist; currently on  increased Effexor dosage.

     Thanks to Rae Montor for the various comments, the
coaching, and  the phrase "concatenation of nostrums".

     To Jeffrey Kramer, your comments were very helpful in 
crystallizing some of the dynamics of the case for me.  Very
valuable  stuff.

     To Paul King, I was intrigued by your questionging of my 
client's use of humor.  She DOES, in my mind, have an engaging
and  dry humor.  I seem to notice it more than she herself
does.  I'd be  interested in hearing more of where your
thoughts lead in this area.

     Thanks to Jim Scheel for the SAD and anniversary reaction
questions.  I'd like to hear more about your ideas on the
connection  between panic attacks and repressed rage.

     Thanks also to Rami Kaminski for your e-mailed

     To Kaan Ozbayrak, your comments on the relationship
between myself and the attending psychiatrist were  accurate. 
I've shared several cases with him over the years and like 
him personally; he agreed to the switch in psychiatrists upon
the  patient's hospitalization.

        I think it's hard for MD's in these managed-care cases
to be  as enthused about a case, since they are authorized
such short and  infrequent times for medication evaluations,
and non-MD therapists  such as myself engage in the lion's
share of time with the patient.

     I learned a great deal from the posts by Bill Bennett,
Mike  Johnson, George Nasra and other MD's who shared your
knowledge so  skillfully and graciously with me.

     Don Gallup, Marc Bostick and others were also very
responsive.   Sorry if I've missed others.  I only had one
reply that didn't open  any space for dialogue, in a private
post from an MD who seemed  miffed about my presentation for
some reason.

     I'll certainly keep anyone posted who'd like further
follow-up.   I owe you all a buncha favors. is
Bill Herring, LCSW
8097 Roswell Road, Suite A-102
Atlanta, Georgia USA 30350     Telephone: (404) 396-1933

Source-Date: Wed, 3 May 1995 13:39:10 -0400
Subject:  Re: how memories are implanted

Denis Franklin noted:

There were family legends I heard told as a child, to which I
had put such vivid images while listening that I later
believed I had been present at the events themselves... 

This reminds me of yet another kind of "memory" -- which I
note here mostly to amuse: I used to write children's books,
and try them out before sending them to publishers on my
then-young children (those people who have long since turned
into adults); I am not an artist, and therefore all narratives
were verbal only, usually read aloud. One of my daughters,
when she turned 13 or so, asked me for a copy of one of the
books (one which had never been sold), because she wanted to
look at the illustrations again. I told her there weren't any.
She argued heatedly with me about this, because she could
clearly remember every line of them: detailed ink drawings in
a 19th-century-engraving style. I wish: the book might have
been bought if they had existed. (She eventually accepted my
version of reality -- but not without being *very* angry about
it! And, unfortunately, although she could see these
illustrations in memory, she could not reproduce them
[although we both knew they had come from her

This aside, I do wish to applaud Dr. Franklin's view of
metaphorical reality, since it gives as much *emotional*
weight to the events being remembered as does most courtroom
evidence. And although  I do see the point to many legal
actions in this arena, I am not entirely sure that those are
entirely therapeutic activities. After all, what if the
perpetrators of horrible acts are, at the time the memories
are actually recovered, dead? Surely, this does not mean that
the patient is doomed to some kind of permanent hell. Our
purpose seems to be, at least in part, to allow patients to
come into themselves as individuals, and help them stop the
action-reaction enmeshment cycle: does this not mean that
actions that have revenge as their entire motive are
non-therapeutic, since they continue that cycle? Further, is a
lack of ability to "prove" an abuse a basis for reduced rage
(I most sincerely doubt it)?

There do seem to be reasons in some cases, well beyond
"revenge," for court actions. Protection of others (e.g.,
grandchildren) is certainly a reasonable motive. And in those
instances, I do think that "the good of the child" -- the
*present* child, not the remembered one -- must prevail in the
decision of whether to initiate legal action.

Dr. Franklin said:

What is the harm, in the case of a competent adult, in not
assuming that the memories are... true, until such time as
collateral evidence is unearthed...

None, say I. In the case of other children, however, I would
have to cast my vote in entirely the other direction: better
to protect children from possible abuse, than be overly
cautious and abandon them to its certainty. 

     Rae Montor
     Private Practive
     Brookline, MA

Date: Sat May 06, 1995  3:25 pm  CST
Subject: Croatia - Zagreb
Hello everybody,
I am a psychologist, a lecturer at the Dept. of Health
Psychology, College of  Nursing, School of Medicine,
University of Zagreb, Croatia. Also, I am a member  of
Executive Board of NGO "Dobrobit" ("Well Being").
For the past 2-3 months, I've been following with interest
the discussions on  this  mailing list. 
All of you have probably heard about war events in this area
of Europe, started  1991. by the army of ex-Yugoslavia, headed
by Serbs, which attacked Slovenia, Croatia and finally Bosnia
and Herzegovina.
Since then, thousands of persons have been killed, wounded,
missing, tortured,  raped, displaced, lost their families and
homes. People have been traumatized by the most atrocious war
events, aimed mainly at civilians. Although in Croatia  there
is a great number of different experts who have tried to
alleviate  different  consequences of war traumatization,
their number is not great enough. Many  experts from other
countries have helped from the beginning of the war, sharing 
their experiences and knowledge, educating volunteers and
paraprofessionals,  especially in the filled of psychosocial
help and support to war survivors, the  field  which is
well-known to me. I can say that we have managed to establish
a  psychosocial network with the aim of helping those most in
At this very moment, however, we have found ourselves in
a qualitatively new  situation. That is, up fill now, the
events have followed some logic of war,  although the Serbs
attacking Croatia have always been all international 
conventions  committing numerous war crimes. Now, the so
called Serbian paramilitary,  have undertaken terrorist action
against civilian population in Croatia's  capital,  Zagreb,
launching rockets carrying cassette-bombs aimed at targets in
the very  center of the city, such as main squares and
streets, schools, children's  clinic,  railway station,
theater, during lunch time when a lot of people are on the 
streets. This is a situation when a town of 1 million
inhabitants functions  under  constant stress and fear for
life. Not to mention same 100000 displaced persons  from
occupied territories of Croatia and refugees from B&H. Who
have been  taken care of in Zagreb and who have already
experienced numerous war-stresses. This situation has
motivated me to send my message to all of you participating 
in this list for help and support to all the innocents victims
of this war, and  especially to inhabitants of Zagreb who have
no way of protecting themselves  from atrocious terrorist
Serbian attacks.
It is particularly frustrating to have comments of politicians
from some  countries  (e.g. Owen), that this situation is the
expected result of police and military  actions undertaken by
Croatia in the occupied territory of West Slavonia, in  order 
to establish highway and railway communications, and after
Serbs' shooting at  the  drivers on the highway. It would be
the same if someone tried to justify the  terrorist bombing in
Oklahoma City by the actions of the Government of the USA.
Personally, I am involved in NGO "Dobrobit" ("Well
being")offering psychosocial  help to war survivors trough
counseling center, mobile teams who visit them at  their
homes, editing books, video-cassettes and TV broadcasts and
educating both war survivors and relief-workers.
Any advice and help is welcome. Thank you for the attention
you have devoted  to the war survivors in Croatia.

With my sincere regards.

Damir Lucanin
Department of Health Psychology
College of Nursing
School of Medicine
University of Zagreb

Mlinarska cesta 38
41000 Zagreb

Tel: 385 (0)1 278 355
Fax: 385 (0)1 434 181, 385 (0)1 435 750

Source-Date: Sun, 7 May 1995 19:52:56 -0700
Subject:  Re: Lunchmeat and Lists/Advertisers

Not to belabor the point, but Denise (>

)Another idea would be if ALL of us, when we get an
)adverstisement, forward that advertisement back to the
)sender.  They would then see how annoying it is to get
)advertisements.(hopefully if we all do it, they will have a
)full mailbox)

and was sarcastically critiqued by

)As as student studying Psy. and SW, I am profoundly
)enlightened by such posts. Here I have been under the
)impression that people who are "professonal" would have
)mutual and reciprocal respect for each other. With this
)assumption, it seems rather logical to assume, that the
)solution would be to simply state the purpose of the
)discussion group, with compliance by all. Here, I personally
)see, an attempt of some to control another to comply with
)their wishes. Mmmmm, boy, that sure sounds "professional" to
)me (NOT). Regards from a mere student who still has lots to
)learn from all professionals.

Denise's suggestion has a name in Internet lingo: it is called
"mailbombing."  An offensive Internet user is punished by
being flooded by unwanted return email.  Some take this idea
to extremes, and send huge, meaningless files (e.g.,
"core-dumps" - don't ask...) that quickly exceed the user's
email storage limits, or could even imperil the functioning of
his/her host machine, e.g., at AOL.

Mailbombing is not effective with a commercial spammer, who
undoubtedly realizes this is a one-shot deal -- a very
inexpensive advertisement to thousands of people, but one that
cannot be repeated, at least on the same Internet service
provider.  Some feel mailbombing isn't very effective in

Students of psychology and social work soon learn that
supervisors, teachers, and other professionals are human, too.
 When anyone perceives an unprovoked attack, one that breaches
social contract and civility, there's a tendency to "take off
one's gloves" and fight.  It's not the most noble thing about
human nature, but human nature it is.  Please accept our clay
feet and our warts, and yours will be accepted, too.

Besides, how do you know Denise is a professional, and not
your classmate?

Steve Reidbord, MD          (preferred)
Dept. of Psychiatry, UC San Francisco

Source-Date: Tue, 9 May 1995 15:43:10 -0500
Subject:  SSRI's, weight gain and unsubscribe

I generally unsubscribe before leaving on vacation to avoid
mailbox overflow on my return.  I was touched by a colleague's
expression of regret at my unsubscription.  Thanks.  I guess
we are a sort of cybercommunity after all.

As to SSRI's and weight gain, Sam Sussman writes:

) A number of family physicians have noticed considerable
) weight gain with SSRIs .A paradoxical re-action. Please
) comment.
) Thank you SS

Bill Boyer replies:

For every pharmacological action there is an equal, opposite,
(but less common) reaction waiting to be reported.

In my opinion, weight gain is one of the most underrated
side-effects of this group of drugs.  In my experience it is
quite common and often severe. As someone noted, it can be a
late side-effect, occurring after about three months, often
following an initial weight loss.  That may account for why it
is reported as rare in the drug company literature.  In
addition, they presumably have little incentive to publicize
such a finding if they are not compelled to do so by FDA
requirements.  Sexual side-effects are also grossly
underreported.  Package inserts indicate that they occur in
only a few percent of users.  In my experience, it's at least
ten times that common.  It makes you wonder how they asked
about the side-effects.

Thanks all for your continued comments and to you Ivan for
keeping your eye on  the signal-to-noise ratio.

In the words of the Terminator, "I'll be back."


Norman E. Rosenthal, M.D.
Chief, Section on Environmental Psychiatry

Source-Date: Tue, 9 May 1995 23:43:52 -0400
Subject:  Diagnoses and Caffeine

Ken Pope sends to psychotherapy-practice@ John
Leo's essay on diagnoses and personal responsibility ("the
twinkie defense," etc.), which certainly contains, I agree, an
important message about personal accountability and social
values that deserves repeating.  But embedded in the story is
the matter of caffeine and its impact on behavior.
       IMHO, from a psychiatric and psychotherapy standpoint,
as a hazard caffeine is the *most underrated* commonly used
(and ab-used) drug among (possibly a majority of) our
        Ex.:  Ca approx 1980 the NE Journal reported caffeine
use among women @ 2 cups of coffee/day  = the maximum safe
intake (above which the incidence of _bladder cancer_ rises
shraply).  Among men who pump gas, smoke cigarettes, and drink
coffee )) hugely higher rate of same, bladder CA.
      Based on long experience in a psych evaluation and
admissions unit as well as in PRx practice, caffeine plays a
role which should *always* be evaluated among any cohort of
patients, esp where other drug use is present, mood complaints
of any sort, sleep complaints, PTSD Ss or c/o, and certainly
when "anxiety" or "panic attacks" are c/o by pts.
         In a string of cases referred to me for pre-screening
for much larger (and much, much more expensive) workups at our
local fancy panic attack clinic, _every case_  of r/o 'panic
attacks' and 'c/o refractory anxiety attacks' was resolved by
removal of caffeine.       
       In one ongoing, frequently puzzling, 12 yrs of care for
a man with PDD (pervasive developmental disorder r/o adult
autism), in this very cooperative pt all aggressive outbursts,
as well as refractory depressive Ss, were eliminated by
eliminating caffeine. (Pt otherwise managed on a list of
antianx and mood stabilizing preps which have always had mixed
or transient success.)
       In PTSD and AxII anxious folks likewise,
eliminating caffeine, in many cases by a carefully supported
plan of d/c, has delivered excellent results around mood,
sleep, fearfulness, self esteem (?) etc etc.
        One new patient comes in heavily dependent on
marihuana and *Moutain Dew* soda pop (the green stuff) which
carries a *whopping load* of caffeine.  Pt c/o chronic severe
headaches, irritability, sleeplessness or reversal. Pt expr no
interest in changing her grass/Dew lifestyle. Yet grass and
caffeine both run riot on the cerebrovascular
(vasoconstriction/vasodilation) system.  Guess what the tx
plan will include, on the sooner side of eventually?         
      (NB Few moms are aware of the hazards of Dew, even as
they forbid Coke to the kids.)
       In our office, eval of caffeine has become a routine
matter in early eval of nearly all cases now, whether or not
other substances, mood or sleep complaints are presented
  Yrs trly    Bet MacArthur   Cambridge MA

Source-Date: Wed, 10 May 1995 00:09:37 -0400
Subject:  Diagnoses & Personal Responsibility

On Tue, 9 May 1995 Ken Pope ( said: 

)I really liked the following brief essay about the validity
)of diagnoses, bias in assigning diagnoses, and personal
)responsibility.  I wish it were read in all clinical
)training programs so that the questions it raises could be
)widely discussed. 

I agree wholeheartedly and am glad to start some discussion

 Wouldn't it be wonderful if we all announced that we have no
basis for *professional* opinions about how society ought to
assess or define personal responsibility? That our thoughts on
the topic belong on the Op-Ed page, along with those of the
lawyers and the Indian chiefs?  That society had better get us
out of this part of the judicial process *before* we approach
100% objectivity, validity, and reliability in diagnosis,
because once we do, we'll be enthroned as the 21st century
version of Dostoevski's  Grand Inquisitor? 

Maybe then the legal profession would reflect on the contempt
implicit in the broader tendency to shift responsibility for
reaching verdicts from the shoulders of a defendant's peers to
"answers from the back of the book" obligingly provided by
experts.  The relationship between "diminished capacity" and
diminished responsibility rests on a society's values and
goals.  It is, IMO, essentially a political equation,
disciplined by explicit principles of due process and the
weight of tradition.  Experts, and especially social and
behavioral science experts seem to me to be pressed into
service (or volunteering) as the sort of philosoper-kings
whose citizenship carries greater authority than that of the
carpenter, secretary, or sales rep sitting on the jury. 
Perhaps it makes lawyers feel more secure to shape trials as a
contest between champions in the art of intimidating plain
folks, but  the nagging thought persists that it is making the
process more chaotic and eroding public trust in the rule of

Do you agree? Do you think our professions could do anything
to turn the tide? 

Thomas V. Maguire, Ph.D.