I have been a member of our American Psychiatric Association (APA) for over 30 years. I've also been a Fellow for many years, served on the Assembly 3 different times, served on the Managed Care Committee twice, and was once asked if I would consider running for President. On the other hand, I did resign from a request to run for District Branch President because of some unexpected (and what I and some others thought was unethical) collegial conflict. Despite all this involvement (or is it because of it?) I've come closer and closer to resigning. Please forgive any apparent or real narcissism as I continue to review my APA history, as I hope that it will relate to issues relevant to others of you and the APA.
Last year, I reinstated my lapsed membership (which is a more passive way to resign), only because it felt inappropriate to not be a member after my children were asked to lead the Workshop on Children of Psychiatrists at the upcoming annual meeting. I had made my concerns known, and did hear from Membership Chair, but not from anyone else in the organization.
There are several reasons I see to now process my concerns in this more public forum. One is that I've just received the first request for the annual dues payment. More importantly, our fellow blogger, Michael Blumenfield, MD, just wrote a distressing piece on "Inside the APA—Budget Cuts Hit Assembly and Components.” Given my career of grappling with inadequate funding and the pressures to control costs, what Dr. Blumenfield described is not unexpected in these times. However, the lack of creativity and the particular choices are driving me closer to resignation.
Take the dissolved Disaster Committee. Why disband that when disasters around the world and climate instability seems to be escalating? I had actually asked the APA to consider expanding the charge of the committee beyond acute disasters in order to prepare for the more slow and insidious ones emerging from global warming. I again did not receive any response, despite repeated requests to whom I was told to contact. In Haiti, though the tragic earthquake likely had nothing to do with climate instability, I heard of the compassionate involvement of several individual psychiatrists, as well as the sophisticated participation of psychiatry in the Israeli team, but nothing formal about direct APA involvement on the ground.
As to creativity, why not have this committee and other downsized aspects of the APA communicate with all the electronic tools available? This should be cheap and fast. Unfortunately, the antiquated and poorly functioning member-to-member list-serve, which has promised to be upgraded for months and months, is not a good harbinger of more effective communication.
My concern with the DSM5 process has been well documented—or perhaps too well documented—so I will refrain from more. I still await any personal or public response from APA leadership involved in this project.
Despite many successes over the years, I think the APA has also failed in many other important ways. Although growing numbers of minority psychiatrists have been well mentored in the APA, especially through the fellowship programs, we still have not elected an African-American President. "I Have A Dream" that we will someday achieve competent cultural psychiatry practice, but research indicates that we are still not close.
As a former APA President, Steve Sharfstein, MD, said, we have become too bio-bio-bio. Yes, the APA Treatment Guidelines have been superb and bio-psycho-social in their approach, but they are practically difficult to apply to clinical accountability expectations, and not used by managed care companies.
I have kept in mind a role model for my resignation. Over a decade ago, the late Loren Moser, MD, resigned in a striking letter to the APA President over his concern that the APA was too intertwined with Pharma. Dr. Moser was an innovator in community mental health and the recovery movement. Finally, after many years, we have begun to follow his advice and separate ourselves more from Pharma.
Before I decide on whether to renew or not, I'd appreciate hearing from other psychiatrists. If you are a member of the APA, why? If you are not a member, why not? What do you recommend I do? Thanks for your collegial help.
Before I decide on whether to renew or not, I'd appreciate hearing from other psychiatrists. If you are a member of the APA, why? If you are not a member, why not? What do you recommend I do? Thanks for your colleagial help.
A RESPONSE FROM DR GISE
If you are not a part of the solution, you are part of the problem. You sound liked the party of "no." What have you done for APA? This is thankless work with ups and downs but I feel proud that the Assembly under Steve Sharfstein outlawed participation in interrogations and blessed same sex civil unions, hard fought messy battles not unlike heath care now. When one is young one is passionate, we think we have the answer. As we get older, we learn to "suck it up" and not walk out in a huff or get oneself kicked out. I have not always succeeded in that endeavor. I admire folks who disagree but somehow are able to remain as players in the game. I have found some models for that in APA. Personally I belonged to AMA (which I never liked) for 26 years until they crossed my line in the 1990s supporting bans on so-called "partial birth abortions." Until we moved to Maui in 1995 I had little to do with APA (NY DB Committee on Women, drafted and spoke in a few APA symposia) but I always belonged. Now my dues are less because I joined as a resident and now I am old (68). When we moved to HI I got drafted and have been Assembly Rep, DB President, Area 7 Disaster Rep and lots of other stuff. As head of the Committee on Women, I inherited a movement to include gender differences in DSM V over a decade ago. I am proud to support the Applebaum Report which is now being hotly debated in APA. I do not agree with APAs views on health reform so APA is not my vehicle to express my views on that subject as I try to influence APA. APA could never address my concerns as a consultation liaison psychiatrist which were addressed by speciality organizations. APA cannot be everything to everybody and as important as global warming is, I do not think it is a central concern of APA. I am personally happy that you are fighting (I hope you are) for control of global warming because I am not. One cant do everything. Health reform is my main issue. Dont quit. We need you. Suck up your pride and narcissism (hard) and do what you can to push your colleagues in the directions you support. Breathe in, breath out, think about it.
I play tennis, how many times did I feel like quitting the game in frustration? 41 years later I am glad I can still play singles. Leslie Hartley Gise, MD
