American Psychiatric Association
|American Psychiatric Association|
Logo of the APA
1000 Wilson Boulevard, Suite 1825
|May 2013–2014 President||Jeffrey Lieberman, M.D.|
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. Its some 36,000 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 (DSM). The DSM codifies psychiatric conditions and is used worldwide as a key guide for diagnosing disorders.
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 Insane (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, which will be published in May 2013.
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.
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 76 district associations throughout the US.
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The APA reflects and represents mainstream psychiatry 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.
Publications and campaigns
APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news.
Top five Choosing Wisely® recommendations
In coordination with the American Board of Internal Medicine, the APA proposes five recommendations for physicians and patients. The list was compiled by members of the Council on Research and Quality Care. The APA places a primary focus on antipsychotic medications due to a rapid increase in sales, from $9.6 billion in 2004 to $18.5 billion in 2011.
- Don’t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
- Don’t routinely prescribe 2 or more antipsychotic medications concurrently.
- Don’t prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia.
- Don’t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.
- Don’t routinely prescribe antipsychotic medications as a first-line intervention for children or adolescents for any diagnosis other than psychotic disorders.
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- Adolf Meyer 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 Spitzer was a key figure in the development of later editions of the DSM.
- Donald Ewen Cameron is best known for his MK-ULTRA-related mind-control and behavior modification research for the CIA. Cameron was President of the APA in 1952-1953.
- Current president Jeffrey Lieberman was principal investigator for the NIMH CATIE study.
Drug company ties
In his book Anatomy of an Epidemic (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.
In 2008, for the first time, Senator Charles Grassley asked the APA to disclose how much of its annual budget came from drug industry funds. The APA said that industry contributed 28% of its budget ($14 million at that time), mainly through paid advertising in APA journals and funds for continuing medical education.
Controversies have related to anti-psychiatry 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, Steven 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 APA president of 2009-2010, Alan Schatzberg, has also come under fire after it came to light that he was principal investigator on a federal study into the drug Mifepristone for use as an antidepressant being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.
In the 1964 election, Fact magazine polled American Psychiatric Association members on whether Barry Goldwater was fit to be president and published "The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater." This led to the banning of diagnosing public figures when you have not performed an examination or been authorized to release information by the patient. This became the Goldwater rule.
- Presidents of the American Psychiatric Association
- American Board of Psychiatry and Neurology
- American Group Psychotherapy Association
- American Journal of Psychiatry
- American Psychoanalytic Association
- American Psychological Association
- Diagnostic and Statistical Manual of Mental Disorders
- List of psychiatrists
- Royal College of Psychiatrists
- "American Psychiatric Association". 2012. Retrieved 5 March 2012. "Representing 36,000 physician leaders in mental health."
- "Contact Us." American Psychiatric Association. Retrieved on September 6, 2012. "American Psychiatric Association 1000 Wilson Boulevard Suite 1825 Arlington, VA 22209"
- "Past and Current Views on the Use of Seclusion and Restraint in Treatment - Ozarin 56 (12): 1621 - Psychiatr Serv". Psychservices.psychiatryonline.org. doi:10.1176/appi.ps.56.12.1621-a. Retrieved 2009-08-07.
- "Assembly Debates Name Change, Responds to Prescribing Law - Hausman 37 (12): 6 - Psychiatr News". Pn.psychiatryonline.org. 2002-06-21. Retrieved 2009-08-07.
- http://www.psych.org/about_apa/[dead link]
- "DB Listing". American Psychiatric Association. 2011. Retrieved 5 March 2012.
- Position Statements
- Practice guidelines Practice Guidelines, Psych.org
- Diagnostic and Statistical Manual
- Riba, Michelle (1 April 2005). "APA Offers New Perspective On Psychiatry and Mental Illness". Psychiatric News 40 (7): 3. ISSN 1559-1255.
- "APA Releases List of Common Uses of Psychiatric Medications to Question" (Press release). Arlington, VA: American Psychiatric Association. 2013-09-20. Retrieved 2014-01-27.
- Kuehn, B. M. (2013). "APA Targets Unnecessary Antipsychotic Use". JAMA 310 (18): 1909–1910. doi:10.1001/jama.2013.281140. PMID 24219927.
- "Jeffrey Lieberman, M.D.". Columbia University Department of Psychiatry. 2005–2008. Retrieved May 26, 2013.
- Whitaker, Robert (2010). Anatomy of an Epidemic. Random House (Crown). pp. 276–278. ISBN 978-0-307-45241-2.
- Angell, Marcia (May 18, 2000). "Is Academic Medicine for Sale?". New England Journal of Medicine (342): 1516–1518. doi:10.1056/NEJM200005183422009.
- Bodenheimer, Thomas (May 18, 2000). "Uneasy Alliance: Clinical Investigators and the Pharmaceutical Industry". The New England Journal of Medicine. doi:10.1056/NEJM200005183422024. Retrieved October 4, 2010.
- Rothman, David (April 27, 2000). "Medical Professionalism — Focusing on the Real Issues". The New England Journal of Medicine. doi:10.1056/NEJM200004273421711. Retrieved October 4, 2010.
- Wilson, Duff (October 2, 2010). "Side Effects May Include Lawsuits". The New York Times (The New York Times Company). Archived from the original on 8 October 2010. Retrieved October 10, 2010.
- Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. p. 217.
- "American Psychiatric Association Statement on Diagnosis and Treatment Of Mental Disorders" (pdf) (Press release). American Psychiatric Association. 2003-09-25. Archived from the original on 2004-06-13. Retrieved 2008-11-21.
- Psychiatric participation in interrogation of detainees
- Controversy Continues to Grow Over DSM’s GID Diagnosis
- Sharfstein, SS. (2005) Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly Psychiatric News August 19, 2005 Volume 40 Number 16
- Psychiatric Group Faces Scrutiny Over Drug Industry Ties, New York Times, 2008-07-12
- Stanford Researcher, Accused of Conflicts, Steps Down as NIH Principal Investigator, The Chronicle of Higher Education, 2008-01-08
- Richard A. Friedman (May 23, 2011). "How a Telescopic Lens Muddles Psychiatric Insights". New York Times. Retrieved 2011-05-24.
- "LBJ Fit to Serve". Associated Press. May 23, 1968. Retrieved 2011-05-24. "Publisher Ralph Ginzburg, defendant in a libel suit for an article on a poll of psychiatrists on Barry Goldwater that he conducted in 1964 says ..."