EDITOR'S NOTE—This story and the News-in-Brief items on the legal follow-up and the mandatory assessment (pp. 14-15) have been edited and portions deleted at the direction of the Executive Committee on advice of our legal counsel.
While the Gaskill Proposal received a somewhat more critical appraisal in Board and Council at the December meeting in New York than occurred in Denver last May, both bodies voted by significant majorities to affirm their endorsement of the proposal and also to submit the proposal to the active membership for a vote. Specifically, the Board voted by better than three to one for these motions, and the Council by an even larger majority, with only one in ten voting against the referendum, and one in eight against endorsing the proposal to train nonmedical applicants.
The Gaskill Proposal, the outcome of ten years of study on the question, mandates that the Board on Professional Standards create a national waiver committee to review institute-selected applicants from fields other than medicine in order to assess their professional qualifications for full clinical training. The prerequisite of medical-psychiatric education assures that high standards of professional experience and socialization into a caretaking professional identity have been met by the medical applicant.
The waiver committee is designed to provide a means to assure that nonmedical applicants have similar qualifications. The institutes would be responsible,
as they are now for every applicant, to evaluate the personal character, motivation, integrity, and psychologicalmindedness of such applicants. Thus, the application process of the nonmedical applicant would involve the combined efforts of the individual institute on a local level and the waiver committee on a national level. Matriculation would be delayed until the entire process has been completed, after which the training and career goal of the individual would be identical to his/her medically trained colleague.
The proposal was overwhelmingly endorsed by Board and Council in May, 1985, and the Gaskill Committee was instructed to incorporate into the proposal suggestions emerging from the extensive discussions that had ensued in Denver. Two changes were made in wording; one was designed to eliminate any suggestion of a quota system in the choice of applicants, and the second to eliminate mention of any specific category of mental health professional. This revised version of the Gaskill Proposal was then sent to all active and associate members, and subsequently to all affiliate members.
The issue less quickly settled related to the bylaws question. It was argued that the American Psychoanalytic Association is committed to training physicians, and that to extend our training
beyond that category violates the bylaws of the institution; further, it was argued that the Board itself is at risk, as well as the Association, if we proceed in a way that requires a bylaws change without actually making that change. This argument was countered by reference to the precedent of CORST (involving the training of nonmedical research candidates) which has already been implemented.
It was stated further that the bylaws are concerned with categories of membership, not training per se; it is only if and when nonmedical applicants are actually considered for membership in the American, rather than for training in psychoanalysis via the institutes, that the bylaws issue will be relevant. The intent of the deliberately sketchy Gaskill Proposal is to allow the organization to move ahead cautiously, with maximum flexibility, and with the ability to rethink and revise the issue of nonmedical training at any point along the way; this is consistent with our general policy of conservative, evolutionary, not revolutionary, change. The argument surrounding the question of whether there is a need for change in bylaws if nonmedical training is to be considered led to proposed amendments of the Gaskill Proposal to that effect in both Board and Council. These motions were
defeated by sizable majorities.
Perhaps the most hotly debated issue in both Board and Council concerned the impact of the Gaskill proposal on the medical identity of members of the American. Some felt strongly that following that course would inevitably isolate the organization from medicine and psychiatry and would fatally weaken its ability to attract psychiatrists into analytic training. It was argued also by those who took this position that the unique place in the psychoanalytic world of the American and its members depends upon a connection to the medical community; without this connection, the American would lose its leadership position.
On the other side, it was argued just as forcefully that in order to maintain this leadership position, the American must recruit those who demonstrate outstanding clinical excellence whether they come from medicine or from some allied field. Those who took this position raised the question of whether our primary affiliation really is with medicine, because psychiatry, as it is constituted today, is essentially antagonistic to psychoanalysis, and this position probably will not change.
The proponents of the Gaskill plan reasoned that the proposal is uniquely designed to maintain the highly valued medical identity, at the same time that access is provided to the very best in the widening mental health field. Moreover, because implementation would be both deliberately gradual and constantly monitored, its effects, both adverse and salutary, could be weighed and altered as needed.
In the Council this significant issue was addressed in the form of a motion that the membership be polled, not just in regard to whether they are for or against the Gaskill Proposal, but also as to whether they are for or against training nonmedical candidates per se; the motion was defeated by a slightly less than two to one margin.
An important question that surfaced in the Council concerned the exact nature and significance of this vote by the active membership: Is this to be considered an opinion poll, or is it a vote binding upon the Board? President Edward Joseph explained that while the Gaskill Proposal does not actually require a vote of the membership, because no bylaw change is being proposed, the training of nonmedical applicants is too significant an issue not to seek the voting membership's opinion. Should the results turn out to be overwhelming in one direction or another, the vote would obviously influence the Board, but if the vote is close, further exploration would be required before a decision on the matter could be reached. In response to a query as to why a simple majority vote could not be considered binding, Dr. Joseph responded that with such a major policy change, the vote, one way or the other, can only be considered as a guide to the Board, who will then develop a procedure, either for implementation or for further study.
In any case, Dr. Joseph stressed that the referendum, and the Gaskill Proposal itself, are very important aspects of a process that has been ongoing for many years. The Gaskill Committee had been asked to develop a proposal on the training of nonmedical applicants that could be voted on by the members, and the Gaskill Proposal successfully serves that purpose. While the Fellows of the Board and the Councilors have had ample opportunity over the years to discuss the vote on the issue, this is the first time that members at large can express their opinions in a clear and definitive manner.