The eighty-eighth Annual Meeting of our Association in Washington, D.C., this past May was like no other meeting ever held by the American. The prodigious efforts of so many of our members and by previous administrations over the past ten years came to real fruition during these meetings. It was clear that the American has become both a profound voice for patient advocacy and a potent force for social change.
Consider, for example, the colorful brochure distributed to Congress, the media, and the mental health community: “Come join us and other members of the concerned public. Focus on: *Privacy.* The Prevention and Resolution of Conflict—between Nations, Groups, Companies, Individuals, and of course, within ourselves.* Freedom and Creativity.”
In addition to the usual sterling quality of our scientific program, presentations on psychoanalytic contributions to issues of deep public concern were highlighted. Since we are so involved in our Association, sometimes it is difficult to appreciate the full scope of the change. However, a glance at titles and topics make it clear how far we have come. On violence: “Unsafe in America: A Psychoanalytic Perspective on Violence,” “Confronting Domestic Violence: A Collaborative Project Using Public Agencies, the Mental Health Community, and Psychoanalysis,” “Psychodynamic Perspectives and Interventions With Juvenile Offenders,” “Psychoanalytically Informed Principles for Intervention in Violent Communities and Organizations,” and “Violence in Film.” On international conflict: “Dialogue Between Diplomats and Psychoanalysts.” On gender issues: Richard Isay's Being Homosexual and Becoming Gay: The Journey to Self-Acceptance. On culture and politics: “Women in Politics: The Difference They Make.”
The theme of our meeting, “Our Political Awakening,” was initiated with media training and political training by Joe Gagen, a consultant to the Texas Medical Society, and Deborah Peel, followed by visits to congressional offices by the participants, who numbered around fifty. This translates into as many as 100 congressional offices contacted by our members speaking out about privacy and other matters vital to our patients. By all accounts, these visits were quite productive, and our members intend to follow up on them.
Aaron Primack of the Health Care Financing Administration (HCFA) attended meetings of CGRI and the Executive Council to clarify Medicare's record-collecting policies. His comments caused concern in some ways, but it is clear that we now have an ongoing dialogue with HCFA. On the positive side, Primack confirmed what we had learned in a prior letter from HCFA—that HCFA feels bound by the protective limits of the Supreme Court decision in Jaffee vs. Redmond.
In other firsts, Rep. Barney Frank (D-Mass.) also addressed Council about health care legislative issues, and Carol Hymowitz of the Wall Street Journal received the first special award given by our Association to a member of the media. Appropriately, the ramifications of Jaffee, so crucial to our profession and our patients, was explored in several formats, including a panel (chaired by Glen Gabbard) of congressional representatives, legal scholars, and APsaA members including Paul Mosher.
The political focus of our meeting culminated in “The Capital Forum — Preserving Privacy, Cornerstone of Quality Health Care,” held within the Capitol Building itself. The meeting was enormously successful in achieving both of our major goals: first, to deliver our message that privacy is essential for psychoanalytic and psychodynamic therapy to as many congressmen as possible; and second, to begin to involve our own members in political advocacy. More than 225 of our own members attended this forum, as well as legislative aides from some twenty-five congressional offices. Participating in the panel were Reps. Edward Markey (D-Mass.), particularly crucial because of his position as chair of the Subcommittee on Information and Technology, and longtime privacy champion Ted Strickland (D-Ohio), the only psychologist in Congress, and as such heavily supported by the American Psychological Association. Harvey Rich and I were also on the panel, representing our Association. The moderator was Mason Essif, producer of “Health Week” on PBS. Representative Markey was especially eloquent in his defense of privacy [see page 33], as were many of our own members in comments from the floor.
The day before the forum; in yet another first, our Executive Council had voted to officially endorse Markey and Strickland's bill in the House of Representatives and the comparable Senate bill, co-sponsored by Sens. Patrick Leahy (D-Vt.) and Ted Kennedy (D-Mass.). Representatives. Markey and Strickland joined us partly to thank our Association for endorsing the privacy bill they are co-sponsoring.
There is one more especially notable “first” about our recent D.C. meeting. It is the first spring meeting in which we have actually shown a profit. Ordinarily, our winter meetings in New York make a considerable amount of money, but each spring meeting has lost many tens of thousands of dollars. Although registration fees have been raised slightly, the main factor seems to be that in this Washington meeting we had many more registrants than usual, both from within our Association and from the wider mental health community.
In fact, more people attended this meeting than any other spring meeting in APsaA history. As has been true in recent meetings, the greater number of younger people attending was very noticeable. Many colleagues mentioned the palpable sense of energy and purpose at the meeting. This was particularly evident at the Executive Council, where a huge amount of work on vital issues was accomplished efficiently and effectively. To me, the greatest accolade for the work of so many people came from several younger members who said, “You know, these meetings are really fun!”
So I think it is appropriate that we should pause and give ourselves a collective pat on the back. Our Association has come through an extremely difficult period of transition. We have come from a position in which our focus was almost exclusively internal. Having isolated ourselves from our professional and public communities, our major preoccupation was almost entirely on scientific programming and training. No organization ever faces a greater challenge than to change its basic nature in the face of external challenge. In his post-presidential address in 1975, “The Mourning Process and Creative Organizational Change,” George Pollack noted,
The avoidance of mourning prevents the acceptance of loss and change — with resulting social and political phenomena that parallel what we may find in individuals
Page 3who cannot change and mourn. It is my belief that the mourning process is the transformational process that provides for adaptation to change.
I believe that this “transformation” is exactly what we have been able to accomplish — to preserve what is valuable about our traditional internal view, but to add to that a crucial external vision. Through our outreach, political action, and public information programs, we are learning to engage the world effectively, to use our analytic knowledge to affect our communities, and to help bring about the social and political changes so vital to our patients and our profession. In a few short years, we have come from virtual obscurity to become serious players on Capitol Hill.
On behalf of our Association, I would like to thank Glenn Good and Deborah Peel, who organized many of the political aspects of the meeting; Warren Procci, chair of CGRI; Howard Levine for the Political Action Group; Jerry Beznos for the brochure; Leon Hoffman and Dottie Jeffries for the media and public information work; Ellen Fertig, Debra Eder, and the central office staff for putting the meetings together; and many, many others.
Having taken a few moments to experience a well-deserved sense of pride in our accomplishments, we now return to the fray. At this writing, the Senate HELP (Health, Education, Labor, and Pensions) committee is finishing its deliberations to combine the bills proposed by Sens. Robert Bennett (R-Utah), Leahy, and Jim Jeffords (R-Vt.). The current working draft seems much closer to the extremely destructive bill of Senator Bennett than to the far more protective bill of Senator Leahy. This seems especially curious as Senator Jeffords is facing a serious re-election challenge in a state noted for its rugged individualism. For him to be seen as shepherding a bill that gives away the privacy rights of individuals to the government and insurance companies would seem politically exceedingly risky. We have mobilized the resources of our Association to contact members of the HELP committee and to work directly through our members in Vermont to establish an ongoing dialogue with the senators state office. We have also been able to be heard through the media, especially in major articles by Robert Pear in the New York Times and Alissa Rubin in the Los Angeles Times. Our Association is the primary organization driving this issue in the HELP committee, just as we did in the “Oasis” data collection scheme by HCFA.
As an update on “Oasis,” the latest from HCFA is that the agency intends to go ahead with data collection, but on a voluntary rather than a mandatory basis, and delivery of services will not depend on patient compliance. This is a huge concession by HCFA and will help us greatly in our future negotiations with them. We can only hope that we are as successful with privacy protection in Congress.
On June 7, I attended the first White House Conference on Mental Health, chaired by Tipper Gore. This was a gala, high-profile — indeed a landmark — event. Beginning with breakfast at the White House (which allowed ample time for networking with representatives of other organizations), addresses followed by Hillary Clinton, Donna Shalala, and Mrs. Gore. The conference then continued at Howard University, with a variety of “break-out” sessions, thirty-two in all. The one I attended was on “Civil Liberties and Privacy” and was chaired by Sen. Joseph Lieberman (D-Conn.). The group was small enough that there was time for real discussion and exchange.
The plenary featured Hillary Clinton, Al and Tipper Gore, and culminated in an address by President Clinton. A number of others spoke about their recovery from various kinds of mental illness, including Mike Wallace, who described his own experience with depression. The afternoon brought a “town meeting” format, chaired by the Gores and featuring giant television screen interactions with a few of the 6,000 “downlink” sites across the nation. The festivities concluded in the late afternoon at the Gore residence with a tent party, which featured a performance by Judy Collins, who spoke of her own struggles with depression and alcohol.
Obviously, this event was designed to attract maximum media attention, which it certainly did. While I am sure some of the motivation was based on the Vice President's election campaign, I was nonetheless impressed with Mrs. Gore's earnest devotion to this cause. While it may stem from her own experience with depression, concerning which she spoke openly and courageously, my impression is that it comes from a much deeper conviction. I had an opportunity to speak directly with Mrs. Gore about our concerns regarding privacy issues and also about our wish to have her speak at one of our future meetings.
While the theme of the conference was about removing the stigma of mental illness and about parity, I did not have the sense that this was the sole focus. While there was considerable emphasis on biologically based mental disorders, this was far from the entire picture. In fact, there were protests from the National Alliance for the Mentally Ill because, in its view, there was insufficient focus on the biologically based illnesses.
Many speakers, especially former patients, spoke movingly of important psychotherapy experiences. In his review of research, Dr. Steve Hyman, the head of NIMH, included slides showing demonstrable changes in the brain as a result of psychotherapy. This was exactly in line with the comments of Dr. Gerald Edelman when he received his honorary membership award from our Association last year. I spoke with Dr. Hyman afterwards, and he seemed quite eager to cooperate with us in our research effort.
Regarding the issue of parity, certainly a laudable goal in itself, it was clear that much education is needed about the dubious value of parity under a managed care system. Parity as a principle is important, in that dollars for mental health should be apportioned on an equal basis to any other health condition. However, the common practice of managed care companies to use the mechanism of “medical necessity” to discriminate against mentally ill patients did not seem openly acknowledged.
Obviously, the follow-through on initiatives generated by this conference will be the true test. However, for our Association the very fact that we were invited to participate means that we have appeared on the government's radar screen as a major organization that must be included in any serious discussion of mental health issues.