During the May meeting of The American, I attended several sessions of the Assembly of the American Psychiatric Association in a liaison capacity. To encourage increased communication and cooperation at this important time in the history of psychiatry, the Assembly has extended what might be called participant observer status to representatives of allied specialties. These representatives, though not accorded voting rights, are invited to participate actively in the Assembly's deliberations. I volunteered to give this time because I think it vital that The American and the APA strengthen the ties between them, ties which unfortunately have been strained in recent years. The education of psychiatric residents, in which I am actively involved, needs an infusion of psychoanalytically trained educators, so that psychoanalysis may nurture the natural attraction it continues to exert on many medical school graduates who choose to enter psychiatry. In my own experience selecting residents, I have observed the same humanistic attitudes, the same curiosity about oneself and others, that motivated many members of The American to choose a career in psychiatry and psychoanalysis. While interest in becoming full-fledged analysts may have diminished among residents, there are many who seek a sophisticated understanding of dynamic psychotherapy—more, in fact, than are presently receiving such instruction.
The APA Assembly, a large body representing state, county, and regional psychiatric societies in all of the states, Puerto Rico, and parts of Canada, is an ideal venue for influencing psychiatric residents (who are well represented there) and their training programs. The Assembly has many working committees, reflecting diverse areas of interest—minority issues, behavioral science research, psychiatry and the law, etc.—that should attract the involvement of analysts. Other members of The American were present at the Assembly as voting representatives; among them were Mervin Stewart of Pittsburgh and Art Farley of Houston-Galveston. Of particular interest to analysts, this meeting witnessed the passing of the gavel of Speaker of the Assembly to Norman A. “Drew” Clemens, immediate past chair of The American's Committee on Government Relations and Insurance. The retiring Speaker, Richard Bitburg of Hartford, was at the forefront of those who developed the APAs inclusive policy of representation for allied groups.
Despite the Assembly's size, I was greatly impressed by the efficiency and thoroughness with which issues are presented to the membership for consideration. The basic process consists of parceling out questions and proposals among the regional area councils, which, after debating and refining them, forward recommendations to the Assembly, which then acts as a committee of the whole.
Naturally, health care reform and the problems of managed care dominated the discussion. There appeared to be strong support among the membership for the right to contract privately; the announcement that language protecting that right had been incorporated in the Kennedy bill was hailed by those present as a victory. Various proposals were made to confront, control, or eliminate managed care abuses and to minimize intrusions into the doctor-patient relationship. These resolutions predominated over those calling for the extension of existing or proposed benefits. Patient advocacy appeared to be the spirit moving much of the debate. For instance, one initiative discussed and supported would define the ethical responsibilities of APA members who participate at the management level of HMOs; it was roundly agreed that the ethical principles involved in patient care and treatment are of the highest priority, and that any failure to maintain them would render one subject to the APAs ethical review procedures.
In short, I was impressed by the proceedings and came away with a further reason to strengthen our ties with the APA. A closer alliance, perhaps through CGRI, with this forty thousand member group would increase our voice in the health care reform debate and in the struggle against managed care abuses, and might also lessen our lobbying costs. It seems to me quite important that psychiatrist members of The American join, or maintain their membership in, the American Psychiatric Association. The costs involved appear well worth it, in terms both of increased political clout and of enhanced relations with the psychiatric profession.