American Psychiatric Association
Encyclopedia
The American Psychiatric Association (APA) is the main professional organization of psychiatrist
s and trainee psychiatrists in the United States
, and the most influential worldwide. Its some 38,000 members are mainly American
but some are international. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders
, or DSM. The DSM codifies psychiatric conditions and is used worldwide as a key guide for diagnosing disorders.
The acronym 'APA' is also commonly used by the American Psychological Association
and its 'APA style guide' for journal articles.
(AMSAII). The group included Thomas Kirkbride
creator of the asylum model which was used throughout the United States. At the meeting they passed the first proposition of the new organization: "It is the unanimous sense of this convention that the attempt to abandon entirely the use of all means of personal restraint is not sanctioned by the true interests of the insane."
The name of the organization was changed in 1892 to The American Medico-Psychological Association to allow assistant physicians working in mental hospitals to become members.
In 1921, the name was changed to the present American Psychiatric Association. The APA emblem, dating to 1890, became more officially adopted from that year. It was a round medallion with a purported facial likeness of Benjamin Rush
and 13 stars over his head to represent the 13 founders of the organization. The outer ring contains the words "American Psychiatric Association 1844." Rush's name and an M.D. The Association was Incorporated
in the District of Columbia in 1927.
In 1948, APA formed a small task force to create a new standardized psychiatric classification system. This resulted in the 1952 publication of the first DSM
. In 1965 a new task force of 10 people developed DSM-II, published in 1968. DSM-III was published in 1980, after a larger process involving some 600 clinicians. The book was now 500 pages long, including many more disorders, and it sold nearly half a million copies. APA published a revised DSM-III-R in 1987 and DSM-IV in 1994, the latter selling nearly a million copies by the end of 2000. DSM-IV-TR with minor revisions was published in 2000. APA is currently developing and consulting on DSM-V, planned for 2012.
In the early 1970s, activists campaigned against the DSM classification of homosexuality as a mental disorder, protesting at APA offices and at annual meetings from 1970 to 1973. In 1973 the Board of Trustees voted to remove homosexuality as a disorder category from the DSM, a decision ratified by a majority (58%) of the general APA membership the following year. A category of "sexual orientation disturbance" was introduced in its place in 1974, and then replaced in the 1980 DSM-III with Ego-dystonic sexual orientation
. That was removed in 1987.
In 2002, amidst increasing concern to differentiate themselves from clinical psychologists, the APA assembly membership voted against a proposed name change to the American Psychiatric Medical Association.
APA reports that its membership is primarily medical specialists who are qualified, or in the process of becoming qualified, as psychiatrists. The basic eligibility requirement is completion of a residency program in psychiatry accredited by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPS(C)), or the American Osteopathic Association (AOA). Applicants for membership must also hold a valid medical license (with the exception of medical students and residents) and provide one reference who is an APA member.
APA holds an annual conference attended by a US and international audience.
APA is made up of some 75 district associations throughout the US.
in the United States. Reflecting larger trends, the APA members and leaders had been largely psychodynamic in their approaches until recent decades, when the field became more "biopsychosocial."
The DSM
is currently intended to be less theoretical than prior editions, having moved away from psychodynamic theories to be more widely accepted, and is proposed to not be committed to a particular theorized etiology for mental disorders. The criteria for many of the mental disorders have been expanded and involve a checklist of so-called 'Feighner Criteria' to try and capture the varying sets of features which would be necessary to diagnose a particular disorder.
APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news.
APA recently launched a health campaign with a new PR approach
(2010), Robert Whitaker
described the partnership that has developed between the APA and pharmaceutical companies since the 1980s. APA has come to depend on pharmaceutical money. The drug companies endowed continuing education and psychiatric "grand rounds" at hospitals. They funded a political action committee
(PAC) in 1982 to lobby Congress. The industry helped to pay for the APA's media training workshops. It was able to turn psychiatrists at top schools into speakers, and although the doctors felt they were independents, they rehearsed their speeches and likely would not be invited back if they discussed drug side effects. "Thought leaders" became the experts quoted in the media. As Marcia Angell wrote in The New England Journal of Medicine (2000), "thought leaders" could agree to be listed as an author of ghostwritten
articles, and she cites Thomas Bodenheimer and David Rothman who describe the extent of the drug industry's involvement with doctors. The New York Times
published a summary about antipsychotic medications in October 2010.
and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. In 1971, members of the Gay Liberation Front
organization sabotaged an APA conference in San Francisco. In 2003 activists from MindFreedom International
staged a 21-day hunger strike, protesting at a perceived unjustified biomedical focus and challenging APA to provide evidence of the widespread claim that mental disorders are due to chemical imbalances in the brain. APA published a position statement in response and the two organizations exchanged views on the evidence.
There was controversy when it emerged that US psychologists and psychiatrists were helping interrogators in Guantanamo
and other US facilities. The American Psychiatric Association released a policy statement that psychiatrists should not take a direct part in interrogation
of particular prisoners but could "offer general advice on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise."
After previous controversy over APA's classification of homosexuality as a mental illness, there is also controversy regarding the remaining category of "sexual disorder not otherwise specified" which can include a state of distress about one's sexual orientation, as well as the diagnosis of "gender identity disorder" or gender dysphoria.
The APA's Standard Diagnostic Manual came under criticism from autism specialists Tony Attwood
and Simon Baron-Cohen
for proposing the elimination of Asperger's syndrome as a disorder and replacing it with an autism
severity scale. Professor Roy Richard Grinker
wrote a controversial editorial
for the New York Times expressing support for the proposal.
The APA president in 2005, Sharfstein, caused controversy when, although praising the pharmaceutical industry, he argued that American psychiatry had "allowed the biopsychosocial model to become the bio-bio-bio model" and accepted "kickbacks and bribes" from pharmaceutical companies leading to the over-use of medication and neglect of other approaches. In 2008 APA became a focus of congressional investigations regarding the way that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions. The drug industry accounted in 2006 for about 30 percent of the association’s $62.5 million in financing, half through drug advertisements in its journals and meeting exhibits, and the other half sponsoring fellowships, conferences and industry symposiums at its annual meeting. APA is considering its response to increasingly intense scrutiny and questions about conflicts of interest. The current APA president, Alan Schatzberg, has also come under fire after it came to light that he was principal investigator on a federal study into a drug being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
s and trainee psychiatrists in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, and the most influential worldwide. Its some 38,000 members are mainly American
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
but some are international. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
, or DSM. The DSM codifies psychiatric conditions and is used worldwide as a key guide for diagnosing disorders.
The acronym 'APA' is also commonly used by the American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
and its 'APA style guide' for journal articles.
History
At a meeting in 1844 in Philadelphia, 13 superintendents and organizers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for the InsaneAssociation of Medical Superintendents of American Institutions for the Insane
The Association of Medical Superintendents of American Institutions for the Insane, also known as The Superintendents' Association, was organized in Philadelphia in October, 1844 at a meeting of 13 superintendents, making it the first professional medical specialty organization in the U.S...
(AMSAII). The group included Thomas Kirkbride
Thomas Story Kirkbride
Thomas Story Kirkbride was a physician, advocate for the mentally ill, and founder of the Association of Medical Superintendents of American Institutions for the Insane , a precursor to the American Psychiatric Association.-Early career:Born into a Quaker family in Morrisville, Pennsylvania,...
creator of the asylum model which was used throughout the United States. At the meeting they passed the first proposition of the new organization: "It is the unanimous sense of this convention that the attempt to abandon entirely the use of all means of personal restraint is not sanctioned by the true interests of the insane."
The name of the organization was changed in 1892 to The American Medico-Psychological Association to allow assistant physicians working in mental hospitals to become members.
In 1921, the name was changed to the present American Psychiatric Association. The APA emblem, dating to 1890, became more officially adopted from that year. It was a round medallion with a purported facial likeness of Benjamin Rush
Benjamin Rush
Benjamin Rush was a Founding Father of the United States. Rush lived in the state of Pennsylvania and was a physician, writer, educator, humanitarian and a Christian Universalist, as well as the founder of Dickinson College in Carlisle, Pennsylvania....
and 13 stars over his head to represent the 13 founders of the organization. The outer ring contains the words "American Psychiatric Association 1844." Rush's name and an M.D. The Association was Incorporated
Incorporation (business)
Incorporation is the forming of a new corporation . The corporation may be a business, a non-profit organisation, sports club, or a government of a new city or town...
in the District of Columbia in 1927.
In 1948, APA formed a small task force to create a new standardized psychiatric classification system. This resulted in the 1952 publication of the first DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
. In 1965 a new task force of 10 people developed DSM-II, published in 1968. DSM-III was published in 1980, after a larger process involving some 600 clinicians. The book was now 500 pages long, including many more disorders, and it sold nearly half a million copies. APA published a revised DSM-III-R in 1987 and DSM-IV in 1994, the latter selling nearly a million copies by the end of 2000. DSM-IV-TR with minor revisions was published in 2000. APA is currently developing and consulting on DSM-V, planned for 2012.
In the early 1970s, activists campaigned against the DSM classification of homosexuality as a mental disorder, protesting at APA offices and at annual meetings from 1970 to 1973. In 1973 the Board of Trustees voted to remove homosexuality as a disorder category from the DSM, a decision ratified by a majority (58%) of the general APA membership the following year. A category of "sexual orientation disturbance" was introduced in its place in 1974, and then replaced in the 1980 DSM-III with Ego-dystonic sexual orientation
Ego-dystonic sexual orientation
Ego-dystonic sexual orientation is an ego-dystonic condition characterized by having a sexual orientation or an attraction that is at odds with one's idealized self-image, causing anxiety and a desire to change one's orientation or become more comfortable with one's sexual...
. That was removed in 1987.
In 2002, amidst increasing concern to differentiate themselves from clinical psychologists, the APA assembly membership voted against a proposed name change to the American Psychiatric Medical Association.
Organization and membership
APA is led by the President of the American Psychiatric Association and a Board of Trustees with an Executive Committee.APA reports that its membership is primarily medical specialists who are qualified, or in the process of becoming qualified, as psychiatrists. The basic eligibility requirement is completion of a residency program in psychiatry accredited by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPS(C)), or the American Osteopathic Association (AOA). Applicants for membership must also hold a valid medical license (with the exception of medical students and residents) and provide one reference who is an APA member.
APA holds an annual conference attended by a US and international audience.
APA is made up of some 75 district associations throughout the US.
Theoretical position
The APA reflects and represents mainstream psychiatryPsychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
in the United States. Reflecting larger trends, the APA members and leaders had been largely psychodynamic in their approaches until recent decades, when the field became more "biopsychosocial."
The DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
is currently intended to be less theoretical than prior editions, having moved away from psychodynamic theories to be more widely accepted, and is proposed to not be committed to a particular theorized etiology for mental disorders. The criteria for many of the mental disorders have been expanded and involve a checklist of so-called 'Feighner Criteria' to try and capture the varying sets of features which would be necessary to diagnose a particular disorder.
Publications and campaigns
APA position statements, Psych.org and practice guidelines and description of its core diagnostic manual the DSM are published.APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news.
APA recently launched a health campaign with a new PR approach
Notable figures
- Adolf MeyerAdolf Meyer (psychiatrist)Adolf Meyer, M.D., LL.D., , was a Swiss psychiatrist who rose to prominence as the president of the American Psychiatric Association and was one of the most influential figures in psychiatry in the first half of the twentieth century...
rose to prominence as the president of the American Psychiatric Association and was one of the most influential figures in psychiatry in the first half of the twentieth century. - Robert SpitzerRobert Spitzer (psychiatrist)Robert L. Spitzer was a major architect of the modern classification of mental disorders. He is a retired professor of psychiatry at Columbia University in New York City, United States and was on the research faculty of the Columbia University Center for Psychoanalytic Training and Research. He...
was a key figure in the development of later editions of the DSM. - Donald Ewen CameronDonald Ewen CameronDonald Ewen Cameron , commonly referred to as "D. Ewen Cameron" or "Ewen Cameron," was a twentieth-century Scottish-born psychiatrist who was involved in the United States Central Intelligence Agency's research on mind control and served as President of the Canadian, American and World Psychiatric...
is best known for his MK-ULTRA-related mind-control and behavior modificationBehavior modificationBehavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of...
research for the CIA. Cameron was President of the APA in 1952-1953.
Drug company ties
In his book Anatomy of an EpidemicAnatomy of an Epidemic
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America is book by Robert Whitaker published in 2010 by Crown. Whitaker asks why the number of Americans who receive government disability for mental illness approximately doubled since 1987...
(2010), Robert Whitaker
Robert Whitaker (author)
Robert Whitaker is an American journalist and author, writing primarily about medicine, science, and history.- Early career :He was a medical writer at the Albany Times Union newspaper, in Albany, N.Y., from 1989 to 1994. In 1992, he was a Knight Science Journalism fellow at MIT. Following that...
described the partnership that has developed between the APA and pharmaceutical companies since the 1980s. APA has come to depend on pharmaceutical money. The drug companies endowed continuing education and psychiatric "grand rounds" at hospitals. They funded a political action committee
Political action committee
In the United States, a political action committee, or PAC, is the name commonly given to a private group, regardless of size, organized to elect political candidates or to advance the outcome of a political issue or legislation. Legally, what constitutes a "PAC" for purposes of regulation is a...
(PAC) in 1982 to lobby Congress. The industry helped to pay for the APA's media training workshops. It was able to turn psychiatrists at top schools into speakers, and although the doctors felt they were independents, they rehearsed their speeches and likely would not be invited back if they discussed drug side effects. "Thought leaders" became the experts quoted in the media. As Marcia Angell wrote in The New England Journal of Medicine (2000), "thought leaders" could agree to be listed as an author of ghostwritten
Ghostwriter
A ghostwriter is a professional writer who is paid to write books, articles, stories, reports, or other texts that are officially credited to another person. Celebrities, executives, and political leaders often hire ghostwriters to draft or edit autobiographies, magazine articles, or other written...
articles, and she cites Thomas Bodenheimer and David Rothman who describe the extent of the drug industry's involvement with doctors. The New York Times
The New York Times
The New York Times is an American daily newspaper founded and continuously published in New York City since 1851. The New York Times has won 106 Pulitzer Prizes, the most of any news organization...
published a summary about antipsychotic medications in October 2010.
Controversies
Controversies have related to anti-psychiatryAnti-psychiatry
Anti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. In 1971, members of the Gay Liberation Front
Gay Liberation Front
Gay Liberation Front was the name of a number of Gay Liberation groups, the first of which was formed in New York City in 1969, immediately after the Stonewall riots, in which police clashed with gay demonstrators.-The Gay Liberation Front:...
organization sabotaged an APA conference in San Francisco. In 2003 activists from MindFreedom International
MindFreedom International
MindFreedom International is an international coalition of over one hundred grassroots groups and thousands of individual members from fourteen nations. It was founded in 1990 to advocate against forced medication, medical restraints, and involuntary electroconvulsive therapy. Its stated mission is...
staged a 21-day hunger strike, protesting at a perceived unjustified biomedical focus and challenging APA to provide evidence of the widespread claim that mental disorders are due to chemical imbalances in the brain. APA published a position statement in response and the two organizations exchanged views on the evidence.
There was controversy when it emerged that US psychologists and psychiatrists were helping interrogators in Guantanamo
Guantanamo Bay detainment camp
The Guantanamo Bay detention camp is a detainment and interrogation facility of the United States located within Guantanamo Bay Naval Base, Cuba. The facility was established in 2002 by the Bush Administration to hold detainees from the war in Afghanistan and later Iraq...
and other US facilities. The American Psychiatric Association released a policy statement that psychiatrists should not take a direct part in interrogation
Interrogation
Interrogation is interviewing as commonly employed by officers of the police, military, and Intelligence agencies with the goal of extracting a confession or obtaining information. Subjects of interrogation are often the suspects, victims, or witnesses of a crime...
of particular prisoners but could "offer general advice on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise."
After previous controversy over APA's classification of homosexuality as a mental illness, there is also controversy regarding the remaining category of "sexual disorder not otherwise specified" which can include a state of distress about one's sexual orientation, as well as the diagnosis of "gender identity disorder" or gender dysphoria.
The APA's Standard Diagnostic Manual came under criticism from autism specialists Tony Attwood
Tony Attwood
Tony Attwood is an English psychologist who lives in Queensland, Australia and is an author of several books on Asperger's Syndrome....
and Simon Baron-Cohen
Simon Baron-Cohen
Simon Baron-Cohen FBA is professor of Developmental Psychopathology in the Departments of Psychiatry and Experimental Psychology at the University of Cambridge in the United Kingdom. He is the Director of the University's Autism Research Centre, and a Fellow of Trinity College...
for proposing the elimination of Asperger's syndrome as a disorder and replacing it with an autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
severity scale. Professor Roy Richard Grinker
Roy Richard Grinker
Roy Richard Grinker is an author and Professor of Anthropology, International Affairs, and Human Sciences at The George Washington University.Grinker is an authority on North and South Korean relations...
wrote a controversial editorial
Editorial
An opinion piece is an article, published in a newspaper or magazine, that mainly reflects the author's opinion about the subject. Opinion pieces are featured in many periodicals.-Editorials:...
for the New York Times expressing support for the proposal.
The APA president in 2005, Sharfstein, caused controversy when, although praising the pharmaceutical industry, he argued that American psychiatry had "allowed the biopsychosocial model to become the bio-bio-bio model" and accepted "kickbacks and bribes" from pharmaceutical companies leading to the over-use of medication and neglect of other approaches. In 2008 APA became a focus of congressional investigations regarding the way that money from the pharmaceutical industry can shape the practices of nonprofit organizations that purport to be independent in their viewpoints and actions. The drug industry accounted in 2006 for about 30 percent of the association’s $62.5 million in financing, half through drug advertisements in its journals and meeting exhibits, and the other half sponsoring fellowships, conferences and industry symposiums at its annual meeting. APA is considering its response to increasingly intense scrutiny and questions about conflicts of interest. The current APA president, Alan Schatzberg, has also come under fire after it came to light that he was principal investigator on a federal study into a drug being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.
See also
- Presidents of the American Psychiatric Association
- American Board of Psychiatry and NeurologyAmerican Board of Psychiatry and NeurologyThe American Board of Psychiatry and Neurology, Inc. is a nonprofit corporation that was founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and the then Section on Nervous and Mental Diseases of the American...
- American Group Psychotherapy AssociationAmerican Group Psychotherapy AssociationThe American Group Psychotherapy Association is a not-for-profit multi-disciplinary organization dedicated to enhancing the practice, theory and research of Group Psychotherapy.-Membership:...
- American Journal of PsychiatryAmerican Journal of PsychiatryThe American Journal of Psychiatry is a monthly peer-reviewed medical journal covering all aspects of psychiatry and the official journal of the American Psychiatric Association. The first volume was issued in 1844, at which time it was known as the American Journal of Insanity...
- American Psychoanalytic AssociationAmerican Psychoanalytic AssociationAmerican Psychoanalytic Association is an association of psychoanalysts in the United States. It was founded in 1911, and forms part of the International Psychoanalytical Association.-External links:**...
- American Psychological AssociationAmerican Psychological AssociationThe American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
- Antipsychiatry
- Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
- List of psychiatrists
- Royal College of PsychiatristsRoyal College of PsychiatristsThe Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom responsible for representing psychiatrists, psychiatric research and providing public information about mental health problems...