LETTERS
TO
THE
Am
EDITOR
excluded as the third part of the triangle, runs counter to all we know of family relations. Certainly, the lower divorce rate in the military community would point to greater family stability. The military commitment to child care is represented in AR 600-48, which requires that every military installation of more than 2,000 dependents establish a child advocacy program all programs this. In that
has
for the purpose and services for sense, the military
attempted
1970
to implement
report
of the
Children.
Joint
and
the
the
inherent
Commission
philosophy
military
on the
of the
Health of is an issue in this paper, it is the family that have been scapegoated.
If scapegoating
military
of monitoring and coordinating children: Dr. LaGrone ignored is the only community which Mental
into
practice
tests
and
how
of validity,
effective
reliability,
5, Robinson
JA,
Fiman
BC:
Drug
use:
in the Mili1976 J Am Acad
JON
demography
and
A.
SHAW,
Washington,
DON
Psychotherapy
M.D. D.C.
penienced their
by
Replies
and
work
rience
that
crises. SIR:
Dr.
Shaw
refers
to Nietzsche’s
thoughts
on
then betrays his own. His long list of complaints objection not just to what was said but to the fact said at all. simplistic.
He seems I would
least as restrictive ther-or stand with I simply suggested therapist
in his
There
was
The
understanding
idea
itary families is not absurd,
would Dr. him
I was tary
the
an interactional an intrapsychic
of military
to assign
feel
that
there
pathologic that military
because
they
and
reveals an that it was model model
is too is at
and I believe
military
still
in the military, Syndrome.
are
to all military
conditions
members
of the
the literature ‘ ‘
definition
Family
families.
pathology
relevant’ of the
‘
mili-
After
eight
same
on family
process
‘
attempts
‘ ‘
to
have
it
cleared through “channels,’ I was finally told that it would not be cleared because it would hurt the recruiting program. It was only after I left the military that I was able to send it to the Journal. Just how valid is military research ‘
‘ ‘
when
352
or Failure:
many the
and family
obligations.
more
more
and
yet,
their
or to ascertain
immature
work.
and
In the case
represses
as
are
the To to
that have
Consid-
make
women,
been
and ex-
career in
my expe-
career-related
source
be sure, help some
some
,
conflicts
involvement
facing
best
Tex.
M.D.
they
of help
for
a short series of of them regain
are actually
unrealistic
of married
psycho-
expectations
spouses
of
should
also
participate in the consultation. Prescribing psychotherapy carries the implication that a person is sick or has failed in some way because of her own conflicts. Actually, many ofthese women’s problems are the result of their attempts to cope with adverse circumstances in a culture that is still highly ambivalent about women’s success.
Many
women
have
not internalized
we realize. political ing the
More
women’s Like
who
research
biases, mistakes
cultural
values
that
as-
in this area,
“unofficial”
from
cultural
and
roles. the
are one
authors,
torn may
I see
between need
many
part of a committed and the realization to their
single
pursuing not
they do not marry and choice between satisfying
handicap
free
is urgently needed if we are to avoid repeatof the recent past in terms of men’s and
it is derived
that
M.D. ,
Conflicts?
It has also
that
is psychotherapy. may be needed
balance
LAGRONE, Beaumont
a serious
women
however,
these women consultations logically
today
between
which
a system
‘statistical
Better
Psychotherapeutic
women
choice
I doubt,
M.
in Conflict” Carol Nadelson, 1978 issue) discussed the
and having a family. My view are no longer concerned about
from
‘ ‘ ‘
for Women’s
‘ ‘
of view? Dr. Shaw implies that because there is a regulation (AR 600-48) for a commitment to child advocacy, this cornmitment actually exists. There is a difference. Perhaps Dr. Shaw would like to outline for us what actually has been put points
using
sume that they, too, must achieve in the work world to realize their potential. This is further complicated by the fact that we know much less about female-male differences than
system
literature. I would ask ‘relevant. While to publish “The Mili-
word
I attempted ‘ ‘
in the
relationships might naturally therapists should not treat milare
support my point. Shaw refers to the
for
that that
bias
and simplistic. I did not advocate an eithe use of theoretical models in my paper; that a systems model might assist the
no attempt
families, but I do tary from which
evolve.
to feel suggest
or Consultation
SIR: In ‘ ‘Success erations for Women associates (September choices
LaGrone
been,
and standardization.
1979
I. Bloom W: The Chap Clinic revisited. Presented at the 16th Annual Conference of Air Force Behavioral Scientists. Brook’s Air Force Base, Tex, January 1969 2. White JH: Analysis of first year referrals to military child psychiatry clinic. US Navy Med 67: 18-2 1 , 1976
attitudes in a junior and senior high school population. Journal of Drug Education 4:179-185, 1974 4. Schnall S: Child abuse and neglect in the military community. Presented at the Military Family Research Conference, San Diego, Calif. Sept 1-3, 1977 5. Lanier D: A new look at child abuse and neglect in the military family. Ibid 6. Kohn M: Social class and parent-child relationships: an interpretation. American Journal of Sociology 68:471-480, 1963
Dr.
it has
March
REFERENCES
1. McCubbin HS, DahI BB, Hunter EJ (eds): Families tary System. Beverly Hills, Calif. Sage Publications, 2. Kenny JA: The child in the military community. Child Psychiatry 6:51-63, 1967 Frenkel
136:3,
perhaps the military would do well to allow a neutral body of investigators to look at its mental health problems and to publish its report without repression. Finally, there have been other studies that have reached conclusions similar to mine. Bloom’s study was mentioned in my paper (I). Incidentally, his population was similar to the one in San Antonio that Dr. Shaw mentioned. White (2) studied a military population in Portsmouth, Va. , and found that 59% ofhis patients were diagnosed as having a behavior disorder. The family dynamics he described were similar to those in my sample.
REFERENCES
3.
J Psychiatry
only
women
time
but
is that feeling
advancement.
30
career-for
geographic
mobility-
most of these women deviant or different if
have a family. Rather, their deep emotional
marital relationship that family obligations career
approaching
a successful
they needs
face a to be
and to have children may pose a serious This
dilemma
was
il-
Am
J Psychiatry
/36:3,
March
LETTERS
1979
lustrated in a recent article in Fortune magazine ( I ) which discussed a group of women who graduated with M.B.A.s from Harvard Business School in 1973. Some of them said
they had decided not to have children; others dren or planned to do so had given up ambitious for which they are certainly as well prepared
who had chilcareer goals as their male
counterparts. Middle-aged women who opt for a career after raising a family are particularly vulnerable. Age is a handicap in the labor force unless one decides on a low-echelon job. I know women who are self-assertive, have the support oftheir husbands, and have prepared themselves adequately to enter the job market, but who cannot find suitable jobs or do not know how to compete in highly competitive arenas. Some of them end up accepting jobs that give them little satisfaction and that do not utilize their skills and qualifications. Others endure a life ofdiscontent, unable to go back to their former emotional stance, to the times when they were looking forward to that ‘ ‘ room of one’s own’ ‘ our society has been promising, and also unable to negotiate from a position of powerlessness. Their psychological paralysis, which is due to reality factors, is at the root of their depression and other health problems that seriously hamper their family and social relationships. What these women need is not psychotherapy. They need to see consultants from the business and professional fields who are trained to present to them in a peer setting the reali-
ties
they
will confront,
so they
can
make
choices
and
mobility. REFERENCE
1. Robertson W: doing. Fortune,
Women M.B.A.s, Harvard Aug 28, 1978, pp 50-60 CLARA
‘73-How
G.
LIVSEY.
Baltimore,
Dr. Nadelson and Associates
they’re
M.D. Md.
Reply
with
the idea
that
suggesting
psychotherapy
implies that the problem is one of illness. The importance of psychotherapy in facilitating coping or crisis resolution should not be overlooked. A person may use coping and defensive styles that are not in themselves pathologic but can
be maladaptive
to the new
life situations
presented
by a ca-
reer.
Conflicts
that
create
difficulties
in work
achievement
and
satisfaction have long been considered appropriate for psychotherapy, which is then oriented toward facilitating successful adaptation. Traditionally, more men have been seen for problems centering around ‘ ‘ work’ ‘ and more women for concerns about ‘ ‘love. ‘ ‘ With recent cultural changes in roles for women, we are seeing more women who seek psychotherapy for conflicts about achievement and career. We do not advocate that all women with work-related difficulties be seen in psychotherapy; we are making two main
EDITOR
career
woman
who
experiences
conflict
between
her
commitment to her work and to her family may well seek and benefit from psychotherapy so that she can have a better understanding ofherselfand be able to find a more optimal situation. We do not believe, as Dr. Livsey implies, that family obligations necessarily impose a serious handicap on career advancement; on the contrary, the support and fulfillment of marriage and children may enhance one’s energy and creativity. We heartily agree that research in these areas is needed. We believe that we must address issues of existing sex roles and their implications, as well as the process of formulation of goals and expectations for women. Although current evidence indicates that women are often conflicted and do experience role strain, we do not feel that this is a necessary condition. MONA
BENNETT,
M.D.
MALKAH
NOTMAN,
M.D. M.D.
CAROL
NADELSON,
Boston,
A Call
Mass.
for Clarification
SIR: In his article ‘ ‘Psychiatrists and Physical Examinations: A Survey’ ‘ (August 1978 issue), Charles W. Patterson, M.D., stated that Karl Menninger (I) has advised caution in performing physical examinations of psychiatric patients. This statement is potentially misleading because it does not refer to the fact that Dr. Menninger, in the very work cited, emphasized that ‘ ‘the Physical Examination of his patient is one of the psychiatrist’s responsibilities and one of his professional privileges. ‘ ‘ He qualified this statement to reemphasize the obvious-that physical examinations are part of the relationship between doctor and patient and must
be done
SIR: We agree with Dr. Livsey that the problems of integrating career and family are complex and that alternative therapeutic approaches are indicated. We would, however, like to focus on some points where we differ.
We disagree
The
THE
this regard. First, we are concerned that when realconcerning work are raised by a woman who is in the therapist consider them seriously and not as psychopathologic. Second, when a woman presymptoms (e.g. , anxiety, depression, paralyzing concerning her work, which relate to intraconflicts and/or early life experiences and exthese should not be dismissed or seen as merely problem of a working woman.
plan
realistically, according to their individual capacities and their emotional make-up. They need training in problemsolving strategies, in gamesmanship, and in realistic goal setting, and they need a working knowledge of the vicissitudes
of upward
points in ity issues psychotherapy see them sents with ambivalence) psychic pectations, the reality
TO
tactfully.
In fact,
he even
emphasized
the positive
effect a physical examination may have on a psychiatric patient when he stated that the examination ‘ ‘disproves the common error of belief that psychiatrists are only ‘talking doctors,’ not real, honest-to-goodness ‘touching’ doctors.”
In actual on the Hospital therapist
practice,
physical
day of admission and in outpatient partially because
to
examinations
are always
done
the C.F. Menninger Memorial cases prior to assignment of of Dr. Menninger’s influence.
It is important to clarify this matter so as not to discredit Dr. Menninger and other well-rounded psychoanalysts and to avoid widening the artificial gap between psychoanalytically
oriented
psychiatrists
and
other
psychiatrists.
REFERENCE
1. Menninger New York,
KA: A Manual for Psychiatric Grune & Stratton, 1962 N.
GREGORY RONALD
Case
Study,
HAMILTON,
2nd ed.
M.D.
FISHER,
M.D.
Topeka,
Kans.
353
a
TO
THE
Am
EDITOR
excluded as the third part of the triangle, runs counter to all we know of family relations. Certainly, the lower divorce rate in the military community would point to greater family stability. The military commitment to child care is represented in AR 600-48, which requires that every military installation of more than 2,000 dependents establish a child advocacy program all programs this. In that
has
for the purpose and services for sense, the military
attempted
1970
to implement
report
of the
Children.
Joint
and
the
the
inherent
Commission
philosophy
military
on the
of the
Health of is an issue in this paper, it is the family that have been scapegoated.
If scapegoating
military
of monitoring and coordinating children: Dr. LaGrone ignored is the only community which Mental
into
practice
tests
and
how
of validity,
effective
reliability,
5, Robinson
JA,
Fiman
BC:
Drug
use:
in the Mili1976 J Am Acad
JON
demography
and
A.
SHAW,
Washington,
DON
Psychotherapy
M.D. D.C.
penienced their
by
Replies
and
work
rience
that
crises. SIR:
Dr.
Shaw
refers
to Nietzsche’s
thoughts
on
then betrays his own. His long list of complaints objection not just to what was said but to the fact said at all. simplistic.
He seems I would
least as restrictive ther-or stand with I simply suggested therapist
in his
There
was
The
understanding
idea
itary families is not absurd,
would Dr. him
I was tary
the
an interactional an intrapsychic
of military
to assign
feel
that
there
pathologic that military
because
they
and
reveals an that it was model model
is too is at
and I believe
military
still
in the military, Syndrome.
are
to all military
conditions
members
of the
the literature ‘ ‘
definition
Family
families.
pathology
relevant’ of the
‘
mili-
After
eight
same
on family
process
‘
attempts
‘ ‘
to
have
it
cleared through “channels,’ I was finally told that it would not be cleared because it would hurt the recruiting program. It was only after I left the military that I was able to send it to the Journal. Just how valid is military research ‘
‘ ‘
when
352
or Failure:
many the
and family
obligations.
more
more
and
yet,
their
or to ascertain
immature
work.
and
In the case
represses
as
are
the To to
that have
Consid-
make
women,
been
and ex-
career in
my expe-
career-related
source
be sure, help some
some
,
conflicts
involvement
facing
best
Tex.
M.D.
they
of help
for
a short series of of them regain
are actually
unrealistic
of married
psycho-
expectations
spouses
of
should
also
participate in the consultation. Prescribing psychotherapy carries the implication that a person is sick or has failed in some way because of her own conflicts. Actually, many ofthese women’s problems are the result of their attempts to cope with adverse circumstances in a culture that is still highly ambivalent about women’s success.
Many
women
have
not internalized
we realize. political ing the
More
women’s Like
who
research
biases, mistakes
cultural
values
that
as-
in this area,
“unofficial”
from
cultural
and
roles. the
are one
authors,
torn may
I see
between need
many
part of a committed and the realization to their
single
pursuing not
they do not marry and choice between satisfying
handicap
free
is urgently needed if we are to avoid repeatof the recent past in terms of men’s and
it is derived
that
M.D. ,
Conflicts?
It has also
that
is psychotherapy. may be needed
balance
LAGRONE, Beaumont
a serious
women
however,
these women consultations logically
today
between
which
a system
‘statistical
Better
Psychotherapeutic
women
choice
I doubt,
M.
in Conflict” Carol Nadelson, 1978 issue) discussed the
and having a family. My view are no longer concerned about
from
‘ ‘ ‘
for Women’s
‘ ‘
of view? Dr. Shaw implies that because there is a regulation (AR 600-48) for a commitment to child advocacy, this cornmitment actually exists. There is a difference. Perhaps Dr. Shaw would like to outline for us what actually has been put points
using
sume that they, too, must achieve in the work world to realize their potential. This is further complicated by the fact that we know much less about female-male differences than
system
literature. I would ask ‘relevant. While to publish “The Mili-
word
I attempted ‘ ‘
in the
relationships might naturally therapists should not treat milare
support my point. Shaw refers to the
for
that that
bias
and simplistic. I did not advocate an eithe use of theoretical models in my paper; that a systems model might assist the
no attempt
families, but I do tary from which
evolve.
to feel suggest
or Consultation
SIR: In ‘ ‘Success erations for Women associates (September choices
LaGrone
been,
and standardization.
1979
I. Bloom W: The Chap Clinic revisited. Presented at the 16th Annual Conference of Air Force Behavioral Scientists. Brook’s Air Force Base, Tex, January 1969 2. White JH: Analysis of first year referrals to military child psychiatry clinic. US Navy Med 67: 18-2 1 , 1976
attitudes in a junior and senior high school population. Journal of Drug Education 4:179-185, 1974 4. Schnall S: Child abuse and neglect in the military community. Presented at the Military Family Research Conference, San Diego, Calif. Sept 1-3, 1977 5. Lanier D: A new look at child abuse and neglect in the military family. Ibid 6. Kohn M: Social class and parent-child relationships: an interpretation. American Journal of Sociology 68:471-480, 1963
Dr.
it has
March
REFERENCES
1. McCubbin HS, DahI BB, Hunter EJ (eds): Families tary System. Beverly Hills, Calif. Sage Publications, 2. Kenny JA: The child in the military community. Child Psychiatry 6:51-63, 1967 Frenkel
136:3,
perhaps the military would do well to allow a neutral body of investigators to look at its mental health problems and to publish its report without repression. Finally, there have been other studies that have reached conclusions similar to mine. Bloom’s study was mentioned in my paper (I). Incidentally, his population was similar to the one in San Antonio that Dr. Shaw mentioned. White (2) studied a military population in Portsmouth, Va. , and found that 59% ofhis patients were diagnosed as having a behavior disorder. The family dynamics he described were similar to those in my sample.
REFERENCES
3.
J Psychiatry
only
women
time
but
is that feeling
advancement.
30
career-for
geographic
mobility-
most of these women deviant or different if
have a family. Rather, their deep emotional
marital relationship that family obligations career
approaching
a successful
they needs
face a to be
and to have children may pose a serious This
dilemma
was
il-
Am
J Psychiatry
/36:3,
March
LETTERS
1979
lustrated in a recent article in Fortune magazine ( I ) which discussed a group of women who graduated with M.B.A.s from Harvard Business School in 1973. Some of them said
they had decided not to have children; others dren or planned to do so had given up ambitious for which they are certainly as well prepared
who had chilcareer goals as their male
counterparts. Middle-aged women who opt for a career after raising a family are particularly vulnerable. Age is a handicap in the labor force unless one decides on a low-echelon job. I know women who are self-assertive, have the support oftheir husbands, and have prepared themselves adequately to enter the job market, but who cannot find suitable jobs or do not know how to compete in highly competitive arenas. Some of them end up accepting jobs that give them little satisfaction and that do not utilize their skills and qualifications. Others endure a life ofdiscontent, unable to go back to their former emotional stance, to the times when they were looking forward to that ‘ ‘ room of one’s own’ ‘ our society has been promising, and also unable to negotiate from a position of powerlessness. Their psychological paralysis, which is due to reality factors, is at the root of their depression and other health problems that seriously hamper their family and social relationships. What these women need is not psychotherapy. They need to see consultants from the business and professional fields who are trained to present to them in a peer setting the reali-
ties
they
will confront,
so they
can
make
choices
and
mobility. REFERENCE
1. Robertson W: doing. Fortune,
Women M.B.A.s, Harvard Aug 28, 1978, pp 50-60 CLARA
‘73-How
G.
LIVSEY.
Baltimore,
Dr. Nadelson and Associates
they’re
M.D. Md.
Reply
with
the idea
that
suggesting
psychotherapy
implies that the problem is one of illness. The importance of psychotherapy in facilitating coping or crisis resolution should not be overlooked. A person may use coping and defensive styles that are not in themselves pathologic but can
be maladaptive
to the new
life situations
presented
by a ca-
reer.
Conflicts
that
create
difficulties
in work
achievement
and
satisfaction have long been considered appropriate for psychotherapy, which is then oriented toward facilitating successful adaptation. Traditionally, more men have been seen for problems centering around ‘ ‘ work’ ‘ and more women for concerns about ‘ ‘love. ‘ ‘ With recent cultural changes in roles for women, we are seeing more women who seek psychotherapy for conflicts about achievement and career. We do not advocate that all women with work-related difficulties be seen in psychotherapy; we are making two main
EDITOR
career
woman
who
experiences
conflict
between
her
commitment to her work and to her family may well seek and benefit from psychotherapy so that she can have a better understanding ofherselfand be able to find a more optimal situation. We do not believe, as Dr. Livsey implies, that family obligations necessarily impose a serious handicap on career advancement; on the contrary, the support and fulfillment of marriage and children may enhance one’s energy and creativity. We heartily agree that research in these areas is needed. We believe that we must address issues of existing sex roles and their implications, as well as the process of formulation of goals and expectations for women. Although current evidence indicates that women are often conflicted and do experience role strain, we do not feel that this is a necessary condition. MONA
BENNETT,
M.D.
MALKAH
NOTMAN,
M.D. M.D.
CAROL
NADELSON,
Boston,
A Call
Mass.
for Clarification
SIR: In his article ‘ ‘Psychiatrists and Physical Examinations: A Survey’ ‘ (August 1978 issue), Charles W. Patterson, M.D., stated that Karl Menninger (I) has advised caution in performing physical examinations of psychiatric patients. This statement is potentially misleading because it does not refer to the fact that Dr. Menninger, in the very work cited, emphasized that ‘ ‘the Physical Examination of his patient is one of the psychiatrist’s responsibilities and one of his professional privileges. ‘ ‘ He qualified this statement to reemphasize the obvious-that physical examinations are part of the relationship between doctor and patient and must
be done
SIR: We agree with Dr. Livsey that the problems of integrating career and family are complex and that alternative therapeutic approaches are indicated. We would, however, like to focus on some points where we differ.
We disagree
The
THE
this regard. First, we are concerned that when realconcerning work are raised by a woman who is in the therapist consider them seriously and not as psychopathologic. Second, when a woman presymptoms (e.g. , anxiety, depression, paralyzing concerning her work, which relate to intraconflicts and/or early life experiences and exthese should not be dismissed or seen as merely problem of a working woman.
plan
realistically, according to their individual capacities and their emotional make-up. They need training in problemsolving strategies, in gamesmanship, and in realistic goal setting, and they need a working knowledge of the vicissitudes
of upward
points in ity issues psychotherapy see them sents with ambivalence) psychic pectations, the reality
TO
tactfully.
In fact,
he even
emphasized
the positive
effect a physical examination may have on a psychiatric patient when he stated that the examination ‘ ‘disproves the common error of belief that psychiatrists are only ‘talking doctors,’ not real, honest-to-goodness ‘touching’ doctors.”
In actual on the Hospital therapist
practice,
physical
day of admission and in outpatient partially because
to
examinations
are always
done
the C.F. Menninger Memorial cases prior to assignment of of Dr. Menninger’s influence.
It is important to clarify this matter so as not to discredit Dr. Menninger and other well-rounded psychoanalysts and to avoid widening the artificial gap between psychoanalytically
oriented
psychiatrists
and
other
psychiatrists.
REFERENCE
1. Menninger New York,
KA: A Manual for Psychiatric Grune & Stratton, 1962 N.
GREGORY RONALD
Case
Study,
HAMILTON,
2nd ed.
M.D.
FISHER,
M.D.
Topeka,
Kans.
353
a
