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.
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.
References
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