|
APA
Reforms
Within those first few years, 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. The
APA frequently tapped the GAP membership for leadership roles
in the organization. More GAP members were elected to
roles in the organization. More GAP members were elected
to the policymaking APA Council and to other offices.
Within four years, three GAP members were elected president
of the APA. (Drs. William C. Menninger, 1949, George S.
Stevenson, 1950, and Leo H. Bartemeir, 1952), while fourth,
although not then a GAP member, was strongly supported by GAP
members and later joined it (Dr. John C. Whitehorn, 1951).
The first important development
was the creation of the post of Medical Director of the APA,
a full-time job to be filed by a psychiatrist with administrative
capacity. Dr. Daniel Blain, a GAP member with a distinguished
administrative record as wartime head of the U.S. Merchant Marine's
medical service and later as chief of neuropsychiatry in the
Veterans Administration, was chosen for the new post, and served
until 1958. A director of information was also employed
for the first time, on GAP recommendation, making possible a
far wider public and professional comprehension of APA activities
and policies.
A second significant development
was 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. Many of the reforms recommended
by this committee were adopted. Sweeping changes followed,
and since then the APA has become a major force in improvement
of institutional and community mental health facilities, elevation
of general professional standards, expansion of psychiatric
research and training programs, and better relations with other
professional groups. From an extremely low-budgeted organization
operating out of a modest office in New York and actively concerned
almost exclusively with membership problems and arranging the
annual meeting, the APA has grown to a center of wide-ranging
activity housed in large national headquarters in Washington,
D.C. (while retaining the New York office as a branch).
It conducts continuous inspections and evaluations of psychiatric
institutions; holds regional and national research, administrative,
and educational institutes; sponsors and directs research programs
of its own; issues a lively series of periodicals and reports;
and cooperates with other organizations in a variety of activities.
The largely voiceless and powerless association that existed
when GAP was founded has been transformed into an effective
agency that speaks with authority for its 10,000 members, thanks
largely to GAP instigation.
While pushing vigorously for these
and other advances in the nation's central psychiatric body,
GAP addressed itself zealously to the development of committee
activities. Within a year, membership--now on a carefully
selected basis--had grown to about 150, and new committees were
created, including ones on Research, Forensic Psychiatry, Child
Psychiatry, Clinical Psychology, and Industrial Psychiatry.
Inevitably, the GAP committees were uneven in their productivity.
Each committee worked on a self-selected topic, usually in conjunction
with invited consultants from allied fields. If, after
sufficient study, a committee felt that the time was ripe, it
would draft a report on the subject. Each report had to
pass through several reviews and revisions before being approved
for GAP publication.
A remarkable amount of work usually
went into these GAP reports. A committee and its consultants,
or substantial numbers of them, might convene many times between
stated GAP meetings, for informal deliberations leading to draft
reports. This was done usually at individual expense.
In one case, a committee chairman spent about $l,500 of her
own money to underwrite meetings of her group during the preparation
of a report.
Several years of study and discussion
often preceded the submission of even a preliminary or draft
report. In many cases a committee decided to explore a
particular psychiatric problem for the mutual enlightenment
of its members, and possibly of the entire GAP, with no report
in prospect. Again, sometimes a committee would draft
a report that would be turned down as falling short of the standard
for GAP publication.
The first GAP report to be published
was on shock therapy. Dated September 15, 1947, it had
been drafted almost a year previously by the GAP Committee on
Therapy, and several revisions had been circulated among the
general GAP membership before it was approved and published.
At the time, a controversy was raging in lay and professional
circles over the use and abuse of electric shock therapy.
Many psychiatric institutions and agencies had appealed for
an authoritative statement on the subject. As the GAP
report noted: Both the extravagant claims as to
its efficacy made by its proponents and the uninformed condemnation
of its use at all by its opponents indicate the emotional aura
which surrounds this whole topic. The report proceeded
to list succinct, clear-cut guides to the proper and safe use
of the technique, to point out specific types of dangerous abuse,
and to urge and outline fruitful areas of research aimed at
definitive evaluation of its efficacy, as well as its further
development.
The report was widely hailed within
the profession as a valuable and long-needed document.
Several critics, however, took strenuous exception to one sentence
in the report that had condemned, without qualification, the
use of electric shock therapy in private-office practice.
As a result of this criticism,
together with the accumulation of new scientific data on the
subject, the Committee on Therapy formulated a revised report
on electric shock. This was published in August, 1950,
as GAP Report No. 15. For one thing, the Committee modified
its blanket condemnation of private-office use of electric shock,
declaring that such use was warranted for carefully selected
cases under carefully controlled conditions, which it specified.
In redrafting this report, the GAP Committee utilized the consulting
services of such experts as Drs. A.E. Bennett, Karl M. Bowman,
Paul H. Hoch, Lothar B. Kalinowsky, and Robert B. McGraw.
It was to become a standard policy that all GAP reports were
subject to revision in the light of new data or fresh ideas.
Thereafter GAP reports were published
at the average rate of three or four a year. Forty-one
had appeared by January, 1959. 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. It was at first anticipated that the GAP
reports would be published in psychiatric journals exclusively,
but this plan was soon abandoned, mainly for two reasons:
difficulties in having GAP reports published regularly in the
American Journal of Psychiatry and a growing conviction
that the reports should be widely circulated among such non-psychiatric
groups as might have considerable interest in their statements.
For years, GAP distributed its
reports free of charge. This proved too heavy a financial
burden, and in 1956 the organization arranged with Alex Sareyan
of Mental Health Materials, Inc., 104 East 25th Street, New
York 10, New York, for future distribution of GAP reports and
other publications, at a price that would help cut costs.
|
