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TitleChanging American Psychiatry: A Personal Perspective
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Total Pages436
Table of Contents
List of Plates
About the Author
1 Post–World War II Scene in American Psychiatry
2 A Pathway to Psychiatry
3 Implicit Preparations for a Leadership Role in Psychiatry
4 Reflections During the Search
5 Clarifying the Mission
6 En Route to Equity
7 International Affairs
8 Psychoanalysis
9 Forensic Psychiatry
10 Evidence-Based Diagnosis and Treatment
11 Psychiatric Research
12 Psychiatric Education
13 A Changing Membership
14 Annual Meetings
15 Publications
16 Governance and Leadership
17 Management of External Relationships
18 Social and Community Psychiatry
19 Conclusions
	Appendix 1: Selected Papers
		Appendix 1A: Turning Points in Twentieth-Century American Psychiatry
		Appendix 1B: The Future of Psychiatry
	Appendix 2: American Psychiatric Association Speakers of Assembly of District Branches
	Appendix 3: Presidential Themes for American Psychiatric Association Annual Meetings, 1984–2008
	Appendix 4: Officers of the American Psychiatric Association
	Appendix 5: American Psychiatric Association Membership Figures, 1873–2007
	Appendix 6: Presidents of the American Psychiatric Association
	Appendix 7: American Psychiatric Association Organizational Chart, 2008 and 1986
	Appendix 8: American Psychiatric Association Joint Commission on Government Relations
	Appendix 9: Psychiatry Organizations of Interest
	Appendix 10: American Psychiatric Association Assembly Area Councils by Region
	Appendix 11: Comparison of American Psychiatric Association Area and District Branch Membership, 2002–2007
	Appendix 12: DSM Task Forces and Working Groups
	Appendix 13: American Psychiatric Association Medical Directors
	Appendix 14: American Psychiatric Association Governance System
Document Text Contents
Page 2

Changing American Psychiatry

A Personal Perspective

Page 218

Annual Meetings 195

and indeed a new generation of psychodynamic leaders is now very pop-

ular at the APA meetings. When Glen Gabbard lectures, he draws a very

large audience. His lectures are presented superbly and include discus-

sion of the relationship between neuroscience and psychoanalysis, as,

for example, when he gave the 2004 Adolf Meyer Award Lecture entitled

“Mind, Brain, and Personality Disorders” (Gabbard 2005). Nevertheless

such presentations are the exception; the content and the superb orga-

nization of the industrial symposia dominate the meeting.

There are also relatively few papers on social and community psychi-

atry at the Annual Meeting. This paucity is in part a result of the Institute

on Psychiatric Services’s becoming the primary place for such presenta-

tions. It also reflects some decline in attention currently given to “social

psychiatry.” In the postwar years, the broad definition of social psychi-

atry included social questions issues such as poverty, racial discrimina-

tion, and the Vietnam war. More recently the social issues included for

discussion at the Annual Meeting are those that directly affect psycho-

pathology and its treatment.

Poster materials are selected for prominent display each year. The

hundreds of such posters accepted by the Program Committee cover

varying topics, but the majority involve somatic research. “Academic”

biological psychiatrists would now probably prefer to present their most

exciting new findings at a neuroscience meeting. There is still good mo-

tivation to present at the APA Annual Meeting, but communicating the

most important new findings is best done in more specialized settings.

During the last two decades there has been a surge in international

registrants at the Annual Meeting. The number of registrants from out-

side the United States is nearly equal to the number of American regis-

trants. The international registrants are often the majority of attendees

at certain popular lectures. They enjoy the courses and the industry-

sponsored symposia, and they frequently purchase books in the publish-

ers’ exhibition. Many factors have contributed to this surge. American

psychiatry is now quite popular across the world; DSM-III (American

Psychiatric Association 1980) and DSM-IV (American Psychiatric Asso-

ciation 1994) have had international success, and American psycho-

pharmacological developments have had a major impact worldwide.

Pharmaceutical companies often pay for the travel of foreign psychi-

atrists to the APA Annual Meeting and Institute on Psychiatric Services.

The rate of growth in the number of psychiatrists in some countries has

significantly increased, and information about the APA now reaches a

large segment of this group. The current reduced value of the dollar com-

pared with other currencies makes travel cheaper, and popular tourist

sites, such as New York and San Francisco, add to the attraction of the meet-

Page 219

196 Changing American Psychiatry: A Personal Perspective

ing for many foreign attendees. Equally important in stimulating the

surge were the efforts of the APA’s Office of International Affairs. For-

eign attendees were given personal attention, with a large hotel area

made available for their collective use, and APA staff available there, un-

der the management of Ellen Mercer, to assist them. This genuine hos-

pitality made the visitors feel most welcome, and many have told me

how important it was for their attendance at the meeting. As I have in-

dicated in Chapter 7 (“International Affairs”), the closing of that office

after my departure from the APA was most disappointing to me, and I

was concerned with the long-term effects of the weakened communica-

tion and hospitality. I am pleased that the current APA leadership is in

process of restoring this office. Some of the APA membership wanted to

focus our spending on the many economic problems affecting the profes-

sion, and they perceived international affairs as a luxury. I am a strong ad-

vocate of international activity, even during hard times. International

attendance at Annual Meetings is cost effective in that it brings in dele-

gate fees and increases the sale of publications. Perhaps more impor-

tant, it is a useful source of scientific information; an internationally sen-

sitive American psychiatry has many positive ramifications enhancing

cooperation at multiple levels. Insensitivity to international attendees at

our Annual Meetings is not wise.

Large numbers of psychiatric residents now attend the Annual Meet-

ing. Efforts to make it more attractive to these trainees have included de-

velopment of special targeted learning sessions and social events. The

fact that residents have become elected voting members of APA govern-

ing bodies and are much better organized than before in communicating

with one another heightens the popularity of the Annual Meeting. In ad-

dition, more medical students attend; contacts are made with medical

schools with representatives at the meeting to enable their students to

attend without fee. The trainees who attend seem to adapt much more

efficiently to the complexity and the magnitude of the program. Study of

the sessions popular with the residents and medical students indicates

future as well as current trends in the profession.

The sheer size and complexity of the Annual Meeting has limited the

number of American and Canadian cities where it can be held. Only

Atlanta, Atlantic City, Boston, Chicago, Dallas, Detroit, Los Angeles,

Miami, New Orleans, New York, Philadelphia, San Diego, San Francisco,

Toronto, and Washington, D.C. now have adequate venues with a spa-

cious conference center and nearby large hotels. Many cities that previ-

ously hosted the Annual Meeting quite successfully cannot do so any

more. That is unfortunate, because holding the Annual Meeting in a city

helps to improve the local public image of psychiatry.

Page 435

396 Changing American Psychiatry: A Personal Perspective

Subspecialities. See also Addiction

psychiatry; Child psychiatry;

Forensic psychiatry; Geriatric

psychiatry; Psychosomatic


APA relations with organizations

representing, 236

development of American

psychiatry in postwar period

and, 6, 7, 11

membership of APA and, 185

presidents of APA and, 222

psychiatric education and,


publications of APA and, 206

Substance abuse, 165. See also

Addiction psychiatry

Substance Abuse and Mental Health

Services Administration

(SAMHSA), 346

Sullivan, Harry Stack, 2, 118

Summer Policy Meetings, of APA, 63

Sussex, James, 45

Systems theory, 29, 30

Szasz, Thomas, 12, 48–49

Taintor, Zebulon, 246

Talbott, John A., 214–215, 221, 222,

223, 224, 294

Talkington, Perry C., 45, 223, 228

Tarasoff decision (1976), 119–120

Tarjan, George, 98, 178, 199, 222,

224, 294

Task Force on Terrorism (APA), 93

Tasman, Allan, 98, 223, 295

Tavistock Institute (London), 49

Technological advances, and future

of psychiatry, 282–283

Telepsychiatry, 282–283

Thailand, 51

Theory, integration of with clinical

practice, 284

Tigert, John, 20

Toman, James, 30

Torres, Rosa, 88

Torrey, E. Fuller, 6, 58, 129, 200, 255

Trachtenberg, Robert, 145

Transactional model, 30

Transcultural psychiatry, 86. See

also Cross-cultural psychiatry;

International psychiatry

Treasurer, of APA, 297

Tulane University, 20, 22, 23–25

Ukraine, 18

United Kingdom, and McNaughton

proviso, 120

University of Chicago, 6, 32, 245

University of Cincinnati, 197

University of Florida, 20–21

University of Illinois, 6, 37–40, 49,

53, 179, 245

University of Iowa, 238

University of Maryland School of

Medicine, 215

University of Pittsburgh, 6, 28, 85,


Vartanian, Marat, 88

Veterans Administration, 2

Vice president, of APA, 297

Virginia Tech, 121

Visotsky, Harold, 45, 96, 97, 115, 208

Vogel-Scibilia, Suzanne, 73, 192, 240

Wallerstein, Robert S., 5, 161–162

War, and traumatic neuroses, 2–3.

See also American Civil War;

World War I; World War II

Washington District Branch, of APA,


Washington Psychiatric Society,

61–62, 70–71

Washington Psychoanalytic

Institute, 33

Washington University, 238

Weinberg, Jack, 88–89, 94, 95, 97,

98, 178, 199, 222

Wellstone, Paul, 145

West, L. Jolyon, 93

Page 436

Index 397

Western Psychiatric Institute

(University of Pittsburgh), 28

White, Jack, 208

Wiener, Jerry M., 94, 222, 294

Wilkinson, Charles, 45, 179, 208

Williams, Janet, 136

Wilson, M., 105

Wilson, Paul, 45

Wimberly, Stanley, 20

Women. See also Gender differences

Equal Rights Amendment and

1981 APA Annual Meeting,

197, 221

medical schools and, 157–158

membership of APA and, 64,


Wong, Normund, 92

Work, Henry, 59, 89

Work environment, and social

psychiatry, 250–251

World Congress, of World

Psychiatric Association, 87–88

World Federation for Mental Health,

96, 97, 347

World Health Organization (WHO),

86, 96, 97, 133

World Psychiatric Association

(WPA), 51, 86, 87–88, 96, 98,

116, 121, 123, 223, 347

World War I, 2

World War II, and development of

American psychiatry, 1–3,

21–22, 84, 254, 263–264

Wyden, Ron, 145

Xia Chen-yi, 89–90

Zarin, Deborah, 139

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