The debate on nonmedical training continued at Board and Council at the fall meeting. There were varying accounts of what took place. A number of participants felt that all sides of the question had been stated and restated in detail, that further debate was useless, and that nothing remained but to take some action toward allowing the membership to make its wishes known.
The majority, however, and not always for the same individual reasons, felt that it was not yet time for a vote. First, it is difficult to know yet what questions to put before the members to vote upon. Also, an influential segment of opinion held that we were only beginning to grapple with such core issues as the meaning and value of our medical identity to us in the “real world,” where our prestige, authority to educate, and capacity to protect the quality of our work actually exists.
Perhaps both views are accurate. While it is true that few genuinely new substantive issues were raised, one observer thought he discerned a kind of “medical re-education” process underway for some participants. For example, no dissenting voices could be heard after George Pollock, liaison to and from the American Psychiatric Association, reported that the Board of Trustees of the APA wished to hold a meeting of representatives of both groups so that we could discuss with them our various proposals for nonmedical training before we come to a vote.
Dr. Pollock stated that the issue was not one of opposing or approving our actions, but of a number of APA members who view our actions as having possible impact on themselves and of it having some import to them whether we define ourselves as a medical specialty or not. Some Councilors and Fellows had difficulty feeling reassured that there was no threat or perjorative tone in this request for information or consultation, despite statements to the contrary by many others.
But even some of those who had earlier expressed impatience with the debate felt that a vote was now premature. The mood was cautious.
Others spoke of painful indecision, of multiple identities and sympathies that divided them. One Fellow stated that while he did not want to give up his medical or psychiatric “hat,” he wanted his analytic identity to be dictated by analytic principles—to judge individuals, not groups.
The drift of these discussions was in the direction of sociopolitical and organizational “reality,” and therefore conservatism in relation to change. Few appear to doubt that we can train nonmedical analysts. The issues which many find difficult to accept or predict are sociopolitical. Some say that if we exclude nonmedical analysts, we will not be able to lead them, and others will. We might have a smaller role to play in the dynamic therapies outside as well as inside medical psychiatry.
On the other hand, say others, even if we can train nonmedical people, should we? We are a medical-psychiatric organization and probably that is why we are powerful—for better or worse. Others can and should do it differently. A fundamental change in our organization has wider sociopolitical effects. Those who hold this view believe that as a medical organization, we can tolerate many exceptions, but that we should not change our basic nature.
Many believe that a simple proposal to change membership requirements, such as the Spruiell Committee's Model I, would stand little chance of approval if voted upon now. In line with the mood of considering cautious or modest proposals, many wondered why we could not simply widen the charge of CORST.
A category of special clinical excellence could be added, a small number of specially gifted people could be granted waivers, and our bylaws and organizational identity would be unchanged. Some argued that this would be unfair. In effect, it would be secretly implementing
one of the models (Model III) without consulting the members.
Representatives of a few institutes and societies reported results of polls. Only a few of these had asked for details regarding what specific proposals, if any, individuals might support. The votes were often close, and results varied. Most felt these scattered reports were inconclusive.
The Board decided to try to obtain non-binding, systematic information about the opinions of tire general membership. The Spruiell Committee was charged with the task of designing a questionnaire to be sent to all institutes outlining the various options, which will both inform and poll the institutes, hopefully in preparation for a vote before too long. The committee will report its findings at the spring meeting. It was left to the Council to poll individual members if they wished to do so.
The Council approved a motion that the Executive Committee appoint a committee to act as liaison to the APA, as the Board of Trustees of the APA had requested. This committee will report its findings to the Council at the spring meeting.