Magazine article Clinical Psychiatry News

If I Were President (of Our APA)

Magazine article Clinical Psychiatry News

If I Were President (of Our APA)

Article excerpt

Presidents--or presidential candidates--are on our minds now. Not only are we about a year away from our national presidential election, we also are in the midst of our annual election for officers of the American Psychiatric Association.

No, I'm not one of the candidates this year, so this is not a campaign announcement. Actually, I haven't been asked to consider running for APA president for several years now. Maybe that's partly because some of what I might advocate would be too radical (or just plain wrong). But here I have a chance to advocate, at least along the ethical way.

At its essence, we should remember that the APA is part of an ethical process. That is, it has the potential to meet one of the secondary priorities in the American Medical Association's principles of medical ethics, as stated in the preamble:

"A physician must recognize responsibility to patients first and foremost, as well as to society, and TO OTHER HEALTH PROFESSIONALS,..." (capitals mine).

Obviously for us, the most important group of "other health professionals" comprises our psychiatrist colleagues, whether they are members of the APA or not. In both informal or formal interactions, how well we as colleagues work together can have an important influence on our patients. Also, after a few years of practice, I had come to realize that our relationships with other psychiatrists can be complicated by our own psychiatric knowledge. For example, we often try to analyze or diagnose one another.

As an organization of psychiatrists, the APA can influence things substantially, from the development of diagnostic criteria to treatment guidelines and political advocacy. However, as much as the organization has accomplished and as much as our leadership has been touting our successes, we have much more to do on the ethical way. How about these for starters?

United States Psychiatric Association?

Have you heard of the USPA? Probably not, because no such organization currently uses that name. But what if the American Psychiatric Association were renamed the United States Psychiatric Association (USPA)? (A name change would not be a precedent; the APA has had three different names since 1844).

Why might such a change be useful to us? First, regardless of which discipline claims original rights to the APA acronym, both psychiatrists and psychologists use it. Not surprisingly, each organization often refers to the other as the "little" APA. So when just 'APA" is tossed around, it can be unclear which organization is being cited. Moreover, a Google search of the words "medical psychology" brings up multiple references to psychologists.

Some members of the psychologists' APA want to attain prescribing privileges, and the psychiatrists' APA is strongly opposed. Given that situation, does our organization really want this potential confusion to persist?

It is also important to consider the cultural implications of using the word "American." Although "American" refers to the United States of America (USA), the USA is only part of America--and only part of North America, at that. The continent we call North America includes Canada and Mexico, as well as Central America. Of course, South America is another continent. Each country or area has its own psychiatric associations. I'm sure we don't intend to speak for all of them.

Using the name American Psychiatric Association might seem culturally insensitive (or even inaccurate) at least, and imperialist at worse. Given our poor track record of cultural competence for patients in the United States, perhaps this other kind of cultural insensitivity should not be surprising. I don't know about you, but I'd prefer to be a member of an organization called the United States Psychiatric Association.

For Whom Should the DSM Be?

On the surface, a simple answer is that our Diagnostic and Statistical Manuals (DSMs) should be used to benefit our patients. …

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