Brother Voodoo: Is The Answer Out There?
A recurrent controversy on this blog has been whether Dr. Jericho Drumm (better known as Brother Voodoo) is a psychiatrist or psychologist. In various stories over the years, he’s been referred to as both (sometimes within the same comic). Calling him a psychologist occurs the most frequently, and that seems to be generally accepted. But is it true?
With the recent release of Doctor Voodoo: The Origin of Jericho Drumm, which reprints Brother Voodoo’s first appearance, the question can finally be answered.
A psychiatrist is a medical doctor who specializes in diseases of the mind. They have graduated medical school and followed it up with a four-year residency in Psychiatry. They tend to approach their patients from a medical point of view, which often involves the prescription of medication.
A psychologist, as the name suggests, has a degree in psychology. They tend to approach patients from a more of a psychological point of view than a strictly medical one and their treatment generally involves counseling or psychotherapy. They cannot prescribe medication. If they have an advanced degree (such as a PhD or PsyD), it is entirely correct to address them as “doctor.”
So which is Brother Voodoo?
Here is his first appearance (as Dr. Jericho Drumm) and he is clearly identified as a “noted psychologist.” So that answers the question, right?
Not so fast. Here is Dr. Drumm a page later whipping out his stethoscope and tending to his dying brother. He even pulls out a syringe and medication to administer to him.
It seems that Brother Voodoo’s first appearance only complicates the debate. He is clearly identified as a psychologist, yet he is practicing medicine just a page later. I think it can be chalked up to yet another writer confusing psychiatrist and psychologist, an all too common occurrence. However, given that Drumm’s use of Western medicine is key to his character at this point in the story, I suspect the writer fully intended for him to have medical training, and therefore be a psychiatrist.
All scenes from Strange Tales #169 (reprinted — and it appears re-colored — in Doctor Voodoo: The Origin of Jericho Drumm). Written by Len Wein (though Roy Thomas had some input into the creation of Brother Voodoo as well) and penciled by Gene Colan.
January 14th, 2010 at 5:47 am
As a psychiatrist, I thought I would add a few thoughts. As you mention, a psychiatrist has gone to medical school (to receive an MD or DO) and then done a residency in psychiatry. Residency training in psychiatry these days includes r exposure to a variety of modalities of treatment, including phamacotherapy (medications) and psychotherapy (counseling). This is necessary in order to be an accredited psychiatry training program by the ACGME. Included within the psychotherapy training is exposure to a variety of modalities of psychotherapy, prominent among them cognitive-behavioral therapy and psychodynamic psychotherapy (but not limited to these; there is exposure to other modalities such as dialectical behavioral therapy, couples and family therapy, a variety of group therapies, and others).
Trainees in psychiatry are exposed to the fundamentals of psychoanalytic theory, which essentially began with Sigmund Freud (an MD). Once upon a time, the psychoanalytic community was the dominant force in psychiatry, but a number of people view this sub-specialization to be waning in popularity and influence (there are several factors, including issues around reimbursement, the extra training required for psychoanalysts which includes the time-consuming and intense process of being analyzed one’s self, removal of psychoanalytic theory from the DSM, and the rise of so-called “biological psychiatry”). In any case, the influence of psychoanalytic thought on how we think about psychological functioning, disorders, and psychotherapeutic treatments is undeniable, which is why everyone is at least exposed to it in psychiatric training. Incidentally, psychologists and social workers can become psychoanaylsts as well, so while some psychiatrists are psychoanalysts, not all psychoanalysts are psychiatrists.
Psychiatry residency training also includes rotations in things like medicine, neurology, and emergency medicine (in addition to the exposure one received to these specialties and a variety of others, such as surgery, that one received during medical school).
Training specific to psychiatrists include the assessment and treatment of medical problems present as psychiatric problems (e.g. delirium, psychiatric disorders due to general medical illness), the variety of uses of psychiatric medications (risks, benefits, side effects, drug-drug interactions, etc.), and the interactions between medical and psychiatric illness. Every person graduating from psychiatry residency is required to show competency in providing psychiatric care to inpatients and outpatients, including psychiatric medications and psychotherapy.
Psychologists, as you say, can by PhDs or PsyDs. They go to graduate school instead of medical school, and therefore do not rotate through a variety of medical specialties the way medical students and psychiatry residents do. During the course of their graduate training (after they complete coursework but before receiving their doctorate), they complete an internship in a clinical setting. Psychologists may choose to pursue clinical psychology or research, although they are exposed to the fundamentals of both during their graduate school. Clinical psychologists learn how to do psychotherapy and how to administer standardized psychological assessments. The latter is unique to psychologists (i.e. psychiatrists do not receive this training), and standardized assessments include things like intelligence testing, achievement testing, projective testing (like the Rorschach and Thematic Apperception Test), and a wide variety of others.
In addition to psychiatrists and psychologists, other psychotherapists include many social workers, and a few individuals with an EdD (Doctor of Education) degree.
As many people know, some psychologists have sought the right to prescribe medications (and in a couple of places this apparently has been granted). Anecdotally, most of the psychologists I am friendly with with have no real interest in this; many have told me they would have just gone to medical school and become psychiatrists if this was important to them.
Thank you for the link to Partners in Health. My heart goes out to those who were affected by this terrible earthquake.
January 14th, 2010 at 8:22 am
Isn’t it possible he’s both?
January 14th, 2010 at 9:17 am
Y’know, I have to say, errors like this really irritate me. Don’t comic writers have access to the Internet? Or even watch television?
Heck, I remember a joke about this subject from “Growing Pains,” from years ago. Alan Thicke and his son were on a plane when a woman went into labor. Thicke volunteers to help, saying “I’m a psychiatrist.” The man says, “Doc, she doesn’t THINK she’s having a baby, she’s HAVING A BABY!” And Thicke explains that he’s a medical doctor.
If 20-year-old sitcoms can get it right without benefit of Google, why can’t comic writers?
The other one that annoys me is confusing archaeology and anthropology.
January 14th, 2010 at 12:26 pm
Delecti,
I suppose it would be possible, hard to stomach. I think I can safely say nobody would ever purposely set out to be both — you would just be a psychiatrist. I suppose you could become a psychologist, decide you’d rather be a psychiatrist, and decide to go to medical school. But that would be a heck of a lot of time, effort, and expense, when you already have a professional degree and the ability to diagnose and treat mental illness. I’ve never heard of someone doing this, although I suppose it’s possible.
After I wrote my post, I came up with another possible explanation — what if Jericho Drumm has training as both a paramedic and as a psychologist? That would explain his ability to administer emergency medical care (including medications) to his dying brother, but the “Dr.” part comes from his psychology training. I could imagine a scenario in which one undergoes paramedic training, then in the course of work and life decides that he is really most interested in mental illness, and decides to become a psychologist.. This explanation unfortunately violates Occam’s razor, which would support the much simpler explanation that comic book writers, as a group, have very little understanding of mental illness, its treatment, or the people who provide that treatment.
January 14th, 2010 at 8:50 pm
Me, I suspect that comics exist in a universe where various sorts of training are somehow just easier than they are in our universe. Thus, biochemists build artificially intelligent robots; scrawny 4F rejects get their physiology super-charged, and become expert combatants in very little time; weapons designers are also electronics engineers, computer programmers, hackers, aircraft engineers, and more; one rich kid can learn Sherlock Holmes-level deduction, forensic science, computer hacking, tactics, ninjitsu, a variety of martial arts, weapons training, piloting, and anything else he might need to know — all in a few years; etc.
Given all that, naturally a surgeon can do any sort of surgery, plus become the most awesome sorcerer in the world; and a psychiatrist can pick up the skills of a psychologist (not to mention a mastery of voudoun), with no problems.
Meanwhile, I managed to text a donation to the International Red Cross ten minutes after waking up. Donation by text message is kind of awesome. I hope all the money goes to the relief efforts.
January 14th, 2010 at 9:38 pm
Kudos to you for the note about the earthquake in Haiti.
This is one of the best blogs out there.
January 14th, 2010 at 9:41 pm
Well, I have a vet degree and am getting a PhD. It is more common nowadays to do the MD/PhD or DVM/PhD thing. In fact, I was originally interested in a path residency and there (at least in veterinary pathology) it is almost a requirement to get a PhD while doing one’s residency.
At the time this comic came out (when was that, by the way?) was it necessary (as it seems to be now) to go through an internship and residency? Along the lines of BPK’s suggestion, maybe Brother Vodoo has a PhD in Psychology and a simple MD (graduated from medical school). Would that qualify him to give medications? Perhaps after getting his MD he decided that he preferred research to practice. To run one’s own research it is necessary to get a PhD. Or if he went through the residency who’s to say that it was in psychiatry? Another question might be whether in Haiti at the time of the comic, it was possible to get one’s hands on medication whether or not one is an MD.
In vet med it is still rather uncommon to go through internships and residencies. Most vets are practicing having just had the 4 years of vet school. Would anyone care to comment on when it became obligatory and common to go through an internship and residency after getting the MD? I’m really curious.
January 15th, 2010 at 7:04 am
@Doc BPK: Rorschach tests can only be applied by psycologists?
That reminds me of Dr. Malcolm Long, Rorschach’s shrink in prison… As I recall it, I always thought he was a psychiatrist. But I might be wrong.
Does someone have Watchmen at hand to take a look and see how Alan Moore refers to him?
January 15th, 2010 at 9:06 am
EL, yours is a good question. I do not know all the history of internship and residency developed. For even the most senior doctors I work with, it seems it was that way, but I would also be interested to learn more about how it developed.
These days, technically once you complete an internship (aka the first year of residency, aka the first year after graduation from med school) and pass the final step of the USMLE (step 3, the first two coming during medical school), you can become licensed. If you want to become trained in a specialty — any specialty, including the primary care specialties of internal medicine, pediatrics, and family medicine — you have to do your residency in that specialty. People used to joke during residency about leaving clinical medicine to go work for a company in a capacity as medical doctors, which I believe you could do after your internship. You wouldn’t see any patients, but people would pay you for your “expertise” as a doctor. People used to say if you wanted to, you could “hang up a shingle” and start seeing patients as someone who only finished an internship… I don’t know about this whole idea… it could be an urban legend. If it does really happen, I imagine malpractice insurance would be crazy expensive (and rightly so, as this hypothetical person who never did a residency would be under-trained).
Alberto, I guess I can’t categorically say that only psychologists can administer and interpret the Rorschach; possibly there is some specialized training that non-psychologists can get for that. But the test has been developed, studied, and administered primarily by psychologists. I have never heard of a psychiatrist (or anyone besides a psychologist) giving a Rorschach test as this is traditionally the psychologist’s bailiwick. In the setting of criminal justice, the person administering the test would generally be a forensic psychologist.
One thing I left off my original comment but should be in there for completeness’ sake: advanced practice nurses with specialized training can also provide mental health care, including medications, but also psychotherapy (joining the group of psychiatrists, psychologists, social workers, and the rare EdD that provide psychotherapy).
January 15th, 2010 at 10:23 am
Official Comment
As you mention, once you’ve got your permanent medical license, you can go into practice without completing a residency.
There are at least two good reasons to follow this route:
1. The military uses a fair number of these GMOs (General Medical Officers) — the Navy in particular. For a while, a lot of the Air Force Flight Surgeons were GMOs until the command finally got wise and told them they could only serve one term as a GMO and then they had to finish a residency. (It always amused me that many flight docs, supposedly the best doctors in the Air Force, were actually the least trained. I know I always got annoyed when one of them would try to lecture me about something it was clear I understood much better).
2. Research is a possibility. If you’re doing bench research, why do you need a specialty? Robert Jarvik (artificial heart inventor and Lipitor-shill) never finished residency, and I’m not sure he even finished residency.
On the other hand, if you decide to go into private practice, you aren’t board-certified, so you’ll get paid a lot less, and as you pointed out, malpractice is much higher.
January 15th, 2010 at 10:26 am
Official Comment
Going back to an earlier comment: One of me classmates in medical school was a clinical psychologist (PhD), who decided, as part of an apparent mid-life crisis, he wanted to be a physician.
I’m not sure where he ended up. I think he was going for Family Practice, but the last I heard (years ago), he didn’t Match and had to scramble for a residency spot.
January 16th, 2010 at 12:37 am
@ BPK and Scott: Thank you both very much. Obviously practicing in human medicine is quite different from practicing as a veterinarian — and not just for the obvious reasons! I didn’t even know (until I found this website) that a general practitioner (in human medicine) had to go through a residency; or even that there was a residency for general practice (now called family practice, I guess). In fact, many of my friends are also misinformed (we had a discussion about all this when I first found this website).
January 19th, 2010 at 10:03 am
I used to see a psychologist who was also a registered nurse. Which doesn’t really settle anything but there you go.
February 18th, 2010 at 12:55 pm
OK, so this is a month after this thread was active, but I finally got around to reading the Doctor Voodoo miniseries as well as the Origin of Jericho Drumm one-shot. Now, I haven’t read a lot of other Brother Voodoo other than these, his cameos in New Avengers, and the reprinted Strange Tales that showed up in the one-shot. But it really seems to me that they are intending for him to be both a medical doctor and a psychologist but not really a psychiatrist. Evidence for this are the multiple mentionings of being a psychologist and then separate “medical”-type tools/interventions (such as the stethoscope, syringe). But what really made me think this is that in the current Doctor Voodoo series he appears to be the medical director of a “clinic” which, although not specified outright, appears to be medical and not psychiatric. So, I think that the writers are somehow trying to fuzz over him being both a psychologist and a doctor of medicine who focuses on medical illnesses, rather than a psychiatrist.
It is also noteworthy that in a reprinted narrative from the time of the original Brother Voodoo stories, a mention is made that he was initially intended to be a doctor of sociology, so that clouds things a bit more. But he is referred to as a psychologist in the earliest story arc.
March 16th, 2010 at 12:20 pm
I’m a pending psychologist (defending my PhD next week), and I have met in my career a very few MD/PhD’s in psychiatry/psychology. Most MD/PhD psychiatrists have their PhDs in medical research, not clinical psychology, so it would be illegal for them to claim that they are psychologists. However, I have met MD’s who then got their PhD in clinical psychology (or vice versa), though they often will get a PsyD because it is much shorter (4 years vs. around 6, because research isn’t required for many PsyD programs). I have also met PhD’s who are paramedics and nurse practitioners, so he could be one of those as well.
Additionally, while psychologists are technically the only ones who can do psych assessment, that is slowly changing, as social workers recently won the right to purchase IQ assessment instruments. Also, the Rorschach can technically be used by psychiatrists (or anyone) who has gone through psychoanalytic training at a psychoanalytic institute, which is completely separate from earning either a PhD or MD. However, psychoanalytic training is not very common outside of NY and CA nowadays, so most psychiatrists don’t learn the Rorschach (which is of limited diagnostic value anyway).
Also, as MD’s, psychiatrists can admit and discharge a patient from a hospital. PhD’s, even if working at a hospital, cannot. Thus, if a PhD has a private patient who is suicidal, they still need to have an MD at the hospital admit them.
Leave a Reply
Contact Me
About
Subscribe:
The Best Of...
Special Topics
Archives
Categories
Twitter
Comic Blogs
Medical/Science Blogs
Currently Reading
Arbitrarily Interesting Medical Condition
Syndrome
The Net:
Contents may have settled during shipping. Past results are no guarantee of future performance. No animals were harmed during the production of this product. Void where prohibited by law. All rights reserved. Not valid with other offers or specials. Professional driver on a closed track. Your financial institution may impose other fees. All models are over 18 years of age. Employees must wash hands before returning to work. Results not typical. Many suitcases look alike. 18% gratuity added to tables of six or more.
Do not taunt Happy Fun Ball.
© 2004-2010 Polite Dissent. Powered by WordPress