GAP and the Future of Psychiatry

By John T. Tennison, M.D., FGAP

Copyright November 2002


During the second year of my psychiatry residency, the Department of Psychiatry at the University of Texas in San Antonio nominated me for a GAP fellowship.   At that time, I had not heard of GAP (the Group for the Advancement of Psychiatry).? However, I was soon to learn that although it is smaller in membership than even the American College of Psychiatrists, the Group for the Advancement of Psychiatry’s 187 active members are among the most influential leaders in psychiatry today.?The fact that GAP chooses only 15 GAP fellows every 2 years results in the GAP fellowship being among the most selective honorary fellowships available to psychiatry residents.?In November of 2000, I was honored to learn that I would be among the 15 GAP fellows for 2001-2002.


As a result of being a GAP fellow, I became intrigued and impressed by the exciting history of GAP as conveyed in The Story of GAP by Albert Deutsch1, a publication that can be found at the GAP website. GAP had its beginnings in 1946 with a small group of fifteen psychiatrists, lead by William C. Menninger, who were dissatisfied with the status quo of psychiatric practice at the time.?These “Young Turks,?as they have come to be called, “had been appalled to find how weak was the voice and how vacillating the action of their loosely organized group [the American Psychiatric Association] during the national defense and ensuing wartime emergencies.?sup>1?The Story of GAP noted, “Despite a succession of distinguished officers, the APA was unable to assume professional leadership because of constitutional, procedural, and traditional obstacles.?sup>1?Consequently, “The first years of GAP were characterized by a sharp accent on its action goals.  Significant accomplishments were recorded on two fronts:  vitalization of the American Psychiatric Association and the preparation and publication of GAP committee reports on important psychiatric topics.?sup>1


At the initial meeting of GAP, Dr. Menninger clarified that the founders of GAP “do not want to proselyte numerous members.?The group must be small to be maneuverable.  Personal friendship and allied ties should not count in inviting or joining this group.?sup>1?Thus, unlike membership in the APA, which is open to all psychiatrists, membership in the GAP has been restricted to those who have a demonstrated record of being “thoughtful, industrious, competent, [and] well-established?and being “genuinely interested in advancing psychiatry by this means.?sup>1?Early GAP members wanted the GAP to be an action-oriented organization that would compliment and enhance, rather than rival the APA.?Consequently, all members of GAP are also members of APA.?Yet, in contrast to the APA, GAP is relatively unburdened by the momentum of political and democratic processes that might anchor it, and prevent it from quickly taking new directions.?Thus, GAP members and committees are relatively free to think about whatever they consider important at any given time.

Within a few years after GAP was formed, three of its members were elected president of the APA.  (Drs. William C. Menninger, 1949, George S. Stevenson, 1950, and Leo H. Bartemeir, 1952).?The 1951 APA president, Dr. John C. Whitehorn, was strongly supported by GAP members, and later joined GAP.?As a result of the influence of these four consecutive APA presidents and other early GAP members, ideas from GAP gained substantial leverage in reorganizing the APA.? Several new posts within the APA were established, including the administrative posts of Medical Director and a Director of Information, ?/span>making possible a far wider public and professional comprehension of APA activities and policies.?sup>1?Next came the creation of an APA reorganization committee, “designed to formulate constitutional and other changes leading to modernization and to provide greater opportunities for individual and regional participation and action.?sup>1

          ?In addition to helping reorganize the APA, GAP has focused on producing high-quality reports from its various committees.?The Story of GAP notes, “These reports, circulated in the many thousands among key agencies and individuals throughout the world, were to make a deep imprint on psychiatric progress over the years.?sup>1


Today, in its website welcome, GAP describes itself as “an organization of nationally respected psychiatrists dedicated to shaping psychiatric thinking, public programs, and clinical practice in mental health.?sup>1?


          ?Given today’s proliferation of psychiatric publications, some of which are influenced or biased by pharmaceutical company interests, the existence of GAP gives me reason to be hopeful.?As a result of already being highly selected, GAP reliably produces high-quality thinking and authoritative publications, with less risk of conflicts of interest than publications that might be influenced by their sources of funding.?fake hublot When psychiatrists are collectively accused of being indiscriminate drug pushers who don’t care about getting to know the unique attributes of their patients; or when psychiatrists are accused of blind adherence or over reliance on pathological DSM categories, I find it protective of the reputation of psychiatry to publicly point out the existence of GAP and draw attention to its history of working outside of restrictive medical models.


?/span>Today, GAP meetings are held twice per year:?once in April and once in November.?GAP fellows attend four meetings, all of which are held in White Plains, New York.? The mission remains much the same, and the organization is constructed around 25 committees, each dedicated to exploring and writing about different aspects of psychiatry. omega replica sale Since the most important work that GAP does is at the committee level, all GAP fellows serve on one of the 25 GAP committees.?Given my interest in forensic psychiatry, I requested to serve on the Psychiatry and the Law Committee.


The Psychiatry and the Law Committee has been one of GAP's most influential committees.? According to The Story of GAP, “Its first published report,  Commitment Procedures  (GAP Report No. 4, April 1948) helped to modernize existing laws and regulations in many states and localities.  replica watches sale Its second report, Psychiatrically Deviated Sex Offenders  (GAP Report No. 9, February 1950), was widely praised as the clearest statement of that complex problem to appear in recent years.  rolex replica uk The report embodied, in essence, the advanced thinking of the foremost contemporary experts on the subject, making clear distinctions between morality and the law, and has been quoted repeatedly in lawyers' briefs and court opinions.  Even more influential, perhaps, was its third report,  Criminal Responsibility and Psychiatric Expert Testimony  (GAP Report No. 26, May 1954), which was cited as a basic document in the famous Durham opinion drawn up by Judge David L. Bazelon of the U.S. Court of Appeals, which overthrew the century-old McNaghten  right-and-wrong  rule in federal courts in favor of modern scientific interpretations of human behavior.?o:p>


During each GAP meeting, each of the 25 committees meets one or more times.?The Psychiatry and the Law Committee on which I serve has met three times at each of the four GAP meetings that I have attended.? Each meeting is an intensive session of uninhibited brainstorming and discussion.?Currently, my committee is working on a book on stalking.?We plan to begin publishing portions of the book on the world wide web as the first quarter of 2003.?


GAP Fellows are assigned an official mentor who is an active member of GAP.? Fellows are asked to submit the name of the GAP member they would most like to be their mentor.?Given my interest in forensic psychiatry, the choice was easy.?I requested eminent forensic psychiatrist, Phillip Resnick, who agreed to be my official mentor.?He is a phenomenal teacher and has been remarkably helpful in guiding my career path.


At the last of the four GAP meetings attended by GAP fellows, the fellows present a Plenary Session on a topic of their choosing.?Our group of 15 fellows chose to focus on psychotherapy, an especially timely topic given the recent RRC competency requirements for 5 types of psychotherapy.?We also wanted to explore psychotherapy’s place in relation to our post-9/11/2001 world.? We chose to divide our topic into 3 areas:?Historical, cultural, and political aspects of psychotherapy in psychiatry; replica watches Current educational aspects of psychotherapy training; and Aspects and challenges for residents who want to pursue psychotherapy for themselves.


After having attended my first GAP meeting and having had conversations at length with senior GAP members, I concluded, “Finally!?Here is a group of psychiatrists who are practicing psychiatry in the eclectic, multi-disciplinary way that I envisioned psychiatry before I attended medical school.?o:p>


GAP is a think tank of the most well rounded group of psychiatrists I have ever met.?Its members apply the liberal education of medical school and psychiatric residency training in the broadest way possible.?GAP committees engage in comprehensive analyses of all factors that impinge on mental health, including biological, psychological, sociological, religious, political, and other environmental factors.?GAP does not unnecessarily pathologize or restrict itself to a pathological or disease-based model.?In short, GAP members practice psychiatry in relationship to the whole world.


At GAP meetings, thinking is allowed and encouraged.?In contrast to the rigid, cookbook approach often seen in clinical psychiatry and managed care, the free-thinking atmosphere of GAP has allowed me to be a skeptic and question the status quo of current psychiatric practice, just as the founders of GAP had done years ago.


On Monday morning, April 23, 2001, immediately following my first GAP meeting, I took vacation time to visit the “Top of the World Trade Center?observatory.? Approximately five months later, these towering buildings would not exist. For me, their sudden destruction was a powerful reminder of the impermanence of all material things.


When I returned to White Plains for my second GAP meeting from November 8-10, 2001, I could see Ground Zero lit up as brightly as a professional sports arena from the air as my plane flew north along the Hudson River at dusk.?Despite the tragedy of September 11th, I was struck by the sight of hundreds of remaining skyscrapers and by the thought of the teeming human life remaining within and around these structures.?It occurred to me that these structures and the people in them are no less vulnerable than was the World Trade Center.? Paradoxically, I was put at ease by the thought that we are all vulnerable.?Vulnerability and impermanence are intrinsic facts of life.?No matter who we are, we have a finite window of time on this earth.?Those who lost their lives on September 11th had their window of time tragically shortened.? Yet, for me, remembering that a window of time of uncertain length is all any of us have was reassuring.? These thoughts were good cognitive therapy for me and helped combat a train of thought that might otherwise result in a feeling of hopelessness.


In addition to causing me to think about vulnerability and impermanence, the terrorist attacks of September 11th?resulted in considerable discussion at the last three GAP meetings that I attended.? Jerrold Post, a GAP member and political psychiatrist based in Washington, D.C., has shared his insights with the public and during his GAP plenary session, titled, “Killing in the Name of God:?The psychology of The Radical Fundamentalist Islamist Terrorist.?span style="mso-spacerun: yes">?In particular, Dr. Post emphasized that the terrorists who carried out the Sept. 11th attacks were not diagnosable by DSM-IV-TR standards.?Clearly, failure to meet criteria for mental illness does not lesson the value of considering the psychology of those who would be so destructive.?Further elucidation has come from work done by Vamik D. Volkan, who serves on GAP’s International Relations Committee.?Dr. Volkan’s work helps us to understand how individuals respond when their ethnic or national boundaries are violated.?As a GAP fellow, I have been inspired to see how these and other GAP members work outside the limits traditionally regarded by many as the realm of psychiatry, namely focusing solely on mental illness.

After the attacks of Sept. 11th, psychiatrists have a historical opportunity to look at and consider current psychiatric institutions and practice.?The activities of GAP members have demonstrated to me that, as a psychiatrist, I have not inherited a static job description.?Today’s psychiatrists and the psychiatrists of tomorrow will continue to define and redefine what psychiatry is.?In particular, I believe we in psychiatry should respond to September 11th not only by treating the sequelae of trauma, but also by developing more fully the theory and practice of preventive psychiatry on a worldwide scale.

GAP committees, such as the International Relations Committee, have traditionally looked at mental health on a worldwide scale.?The attacks of Sept. 11th have made it poignantly clear that the lack of mental health or quality of life of people living in the Middle East can lead to drastic results on the other side of the world.?Psychiatrists are well-experienced at dealing with traumas AFTER they have occurred, but there is no reason why psychiatrists should not define themselves as also being formally interested in preventing the traumas of the sort that have occurred as a result of the September 11th attacks.?Sometimes this is as simple as fighting propagandistic lies with truthful propaganda, but at other times, we must look deeper into understanding the complex psychologies of ethnic and religious groups, as the GAP International Relations Committee has done in such publications as Us and Them: The Psychology of Ethnonationalism2 and by the GAP Social Issues Committee’s symposia report, Factors Used to Increase the Susceptibility of Individuals to Forceful Indoctrination: Observations and Experiments.3

The act of publishing reports such as these is not enough to assure that the wisdom contained within them is practically applied.?If we are to practice preventive psychiatry in the highest yield way possible, we must approach and lobby our own and other governments; and run for and accept as many positions within government as possible.

Many of the twenty-five GAP committees are well poised to contribute to a public awareness of psychiatry as being interested in more than mental illness alone.?In the socio-political arena, this broadening of the definition of psychiatry could come from publications and lobbying efforts from the GAP committees on Preventive Psychiatry, International Relations, Government Policy, Psychiatry and the Law, Psychiatry and Religion, Cultural Psychiatry, and Social Issues.?Moreover, the small size of GAP and the influence of its members would likely allow it to contribute to a paradigm shift that would be more difficult to achieve if working solely through an institution as big as the APA.


If psychiatry takes on the preventive role of improving quality of life for as many people as possible, we can move away from using the term, “mental health?merely as a euphemism for “mental illness.?span style="mso-spacerun: yes">?The insights contributed by members of GAP committees can be applied not only in our own country, but also throughout the world. This may be especially important in locations where belief systems, mental health, or quality of life are so poor as to potentially result in the behavioral extremes that occurred on September 11th, 2001.


Despite the advances in psychiatry since GAP’s beginnings in 1946, I still feel poignantly aware of how often the voice of psychiatry remains weak.?Whether it is from struggles to gain parity for mental health in congressional legislation, or from the way psychiatrists are portrayed in the media, it is clear that we have tremendous public relations challenges to overcome if we are to be more persuasive and efficacious in the world at large.


Since the percentage of American psychiatrists who belong to the APA today is declining, the APA’s smaller budget will likely force it to reduce its scope of activities.?Although the specifics of this probable downsizing have not been worked out, the think-tank format of GAP might again be able to contribute ideas that help the APA clarify its priorities and achieve the highest yield for a given budget.

GAP fulfills my dream of what psychiatry should be, namely an eclectic mix of considering any and all factors that might influence mental health, and more generally, human experience itself.?The founders of GAP were freethinking individuals who did not let bureaucracy or the burden of unwieldy institutions stand in their way of doing what was right for psychiatric patients and public mental health in general.?GAP has encouraged me to question paradigms of psychiatry and to remain humble.?GAP allows for thinking outside the box, something that larger organizations, such as the APA, have a harder time doing, given the momentum of their size.

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According to The Story of GAP, within the first few years of its existence, “GAP was mainly responsible for stimulating and executing a thorough-going shakeup in APA policies and operations, raising the venerable organization from a plodding body to an actively responsible one, no longer reluctant to accept a leading role in mental health developments.?sup>1?Once again, the GAP might very well be able to assist the APA in setting its priorities and focusing itself in this time of upheaval.?The history of GAP demonstrates clearly that the APA is fundamentally a democratic organization and is capable of changing.?If we are dissatisfied enough with any aspect of the status quo of psychiatry, we can do something about it.?I hope as many psychiatrists as possible will contribute to this process from the local to the national level.? There is no reason why small groups of skilled and determined individuals cannot make contributions equal to or greater than the ones made by the founders of GAP.  



1.         The Story of GAP, by Albert Deutsch.?New York, 1959

2.         Us and Them: The Psychology of Ethnonationalism (GAP Report 123, 1987), Formulated by the Committee on International Relations

3.         Factors Used to Increase the Susceptibility of Individuals to Forceful Indoctrination: Observations and Experiments (GAP Symposia Report S-3, 1956), Formulated by the Committee on Social Issues




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