American Psychiatric Association

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American Psychiatric Association
AbbreviationAPA
FormationOctober 16, 1844;179 years ago (1844-10-16) [1]
Founders
Founded at Philadelphia, Pennsylvania, US [2]
Type Professional association
52-2168499 [3]
Legal status 501(c)(6) organization [3]
Headquarters Washington, DC, US
Membership
37,400
Rebecca W. Brendel [4]
President-elect
Petros Levounis
Chief executive officer
Saul Levin [5]
Subsidiaries
  • American Psychiatric Association Foundation
  • American Psychiatric Political Action Committee
  • American Psychiatric Association Insurance Trust
  • APA Wharf Holdings LLC [6] [ page needed ]
Revenue (2016)
$50,557,392 [3]
Expenses (2016)$48,736,684 [3]
Employees (2016)
236 [6] [ page needed ]
Volunteers (2016)
850 [6] [ page needed ]
Website psychiatry.org OOjs UI icon edit-ltr-progressive.svg
Formerly called

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. [7] It has more than 38,000 [7] members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. 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 mostly in the United States as a guide for diagnosing mental disorders.

The organization has its headquarters in Washington, DC. [8]

History

At a meeting in 1844 in Philadelphia, thirteen 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. The group was chartered to focus "primarily on the administration of hospitals and how that affected the care of patients", as opposed to conducting research or promoting the profession. [9]

In 1893, the organization changed its name to the American Medico-Psychological Association. [10] In 1921, the association changed that name to the present American Psychiatric Association. [11] The association was incorporated in 1927. [11]

The cover of the publication Semi-Centennial Proceedings of the American Medical Psychological Association, which the association distributed in 1894 at its 50th annual meeting in Philadelphia, contained the first depiction of the association's official seal. [12] The seal has undergone several changes since that time. [12]

The present seal is a round medallion with a purported likeness of Benjamin Rush's profile 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 MD are below the picture. [12] [13]

An association history of the seal states:

The choice of Rush (1746–1813) for the seal reflects his place in history. .... Rush's practice of psychiatry was based on bleeding, purging, and the use of the tranquilizer chair and gyrator. By 1844 these practices were considered erroneous and abandoned. Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry. [12]

In 2015, the association adopted a new logo that depicts the serpent-entwined Rod of Asclepius superimposed over the image of two hemispheres of a human brain. The logo appears next to the words "American Psychiatric Association", with the word "Psychiatric" in bold type; the tagline "Medical leadership for mind, brain and body" appears below the logo. The association will continue to use the seal bearing Rush's profile for ceremonial purposes and for some internal documents. [14]

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 [15] 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.[ citation needed ]

APA holds an annual conference attended by an American and international audience.[ citation needed ]

APA is made up of some 76 district associations throughout the country. [16]

Foundation

APA operates a non-profit subsidiary called the American Psychiatric Association Foundation (APAF), offering community-based programs and research initiatives intended to better understand and support issues of mental health. [17] Its strategic partners include the Council of State Governments (CSG) Justice Center, Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Association of Counties (NACo). [18]

Corporate Alliance

APAF partners with industry organizations to collaborate on mental health research and development through its Corporate Alliance. Current and recent members of the alliance include: [19] [20]

Donors to the foundation in 2019 include the Austen Riggs Center, BB&T, Cenveo, McLean Hospital, Menninger Foundation, NeuroStar, Newport Academy, NewYork-Presbyterian Hospital, Sheppard Pratt, and Silver Hill Hospital. [20]

Publications and campaigns

APA position statements, [21] clinical practice guidelines, [22] and descriptions of its core diagnostic manual (the DSM) are published.

APA publishes several journals [22] 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. [23] 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. [24]

  1. Do not prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
  2. Do not routinely prescribe 2 or more antipsychotic medications concurrently.
  3. Do not prescribe antipsychotic medications as a first-line intervention to treat behavioral and psychological symptoms of dementia.
  4. Do not routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.
  5. Do not routinely prescribe antipsychotic medications as a first-line intervention for children or adolescents for any diagnosis other than psychotic disorders. [23]

Notable figures

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. [33] APA has come to depend on pharmaceutical money. [33] The drug companies endowed continuing education and psychiatric "grand rounds" at hospitals. They funded a political action committee in 1982 to lobby Congress. [33] The industry helped to pay for the APA's media training workshops. [33] 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. [33] "Thought leaders" became the experts quoted in the media. [33] 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, [34] and she cites Thomas Bodenheimer and David Rothman who describe the extent of the drug industry's involvement with doctors. [35] [36] The New York Times published a summary about antipsychotic medications in October 2010. [37]

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 percent of its budget ($14 million at that time), mainly through paid advertising in APA journals and funds for continuing medical education. [38]

The APA receives additional funding from the pharmaceutical industry through its American Psychiatric Association Foundation (APAF), including Boehringer Ingelheim, Janssen Pharmaceuticals, and Takeda Pharmaceutical Company, among others. [19]

Controversies

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 a ban on the diagnosis of a public figure by psychiatrists who have not performed an examination or been authorized to release information by the patient. This became the Goldwater rule. [39] [40]

Supported by various funding sources, the APA and its members have played major roles in examining points of contention in the field and addressing uncertainties about psychiatric illness and its treatment, [41] as well as the relationship of individual mental health concerns to those of the community. Controversies have related to anti-psychiatry and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. In 1970, members of the Gay Liberation Front organization protested the APA conference in San Francisco. [42] 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 [43] and the two organizations exchanged views on the evidence.

The APA's DSM 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 spectrum severity scale. Roy Richard Grinker wrote a controversial editorial for The New York Times expressing support for the proposal.

The APA president in 2005, Steven Sharfstein, praised the pharmaceutical industry but 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. [44]

In 2008 APA was the focus of congressional investigations on how pharmaceutical industry money shapes the practices of nonprofit organizations that purport to be independent. 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. The APA came under increasing scrutiny and questions about conflicts of interest. [45]

The APA president in 2009–10, Alan Schatzberg, was identified as the principal investigator on a federal study into the drug mifepristone for use as an antidepressant being developed by Corcept Therapeutics, a company Schatzberg had created and in which he had several million dollars' equity. [46]

In 2021, the APA issued an apology for its historical role in perpetuating racism. [47]

See also

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.

<i>Diagnostic and Statistical Manual of Mental Disorders</i> American psychiatric classification

The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is the main book for the diagnosis and treatment of mental disorders in the United States and Australia, while in other countries it may be used in conjunction with other documents. The DSM-5 is considered one of the principal guides of psychiatry, along with the International Classification of Diseases ICD, CCMD, and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

The biopsychiatry controversy is a dispute over which viewpoint should predominate and form a basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics include disparate groups such as the antipsychiatry movement and some academics.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">DSM-5</span> 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, not all providers rely on the DSM-5 for planning treatment as the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, and perceptions.

<span class="mw-page-title-main">Jeffrey Lieberman</span> American psychiatrist (born 1948)

Jeffrey Alan Lieberman is an American psychiatrist who specializes in schizophrenia and related psychoses and their associated neuroscience (biology) and pharmacological treatment. He was principal investigator for CATIE, the largest and longest independent study ever funded by the United States National Institute of Mental Health to examine existing pharmacotherapies for schizophrenia. He was president of the American Psychiatric Association from May 2013 to May 2014.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

<span class="mw-page-title-main">Goldwater rule</span> Rule governing how psychiatrists may give opinions on public figures

The Goldwater rule is Section 7 in the American Psychiatric Association's (APA) Principles of Medical Ethics, which states that psychiatrists have a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health, and when they are asked to comment on public figures, they refrain from diagnosing, which requires a personal examination and consent. It is named after former US Senator and 1964 Republican presidential nominee Barry Goldwater.

Henry Brill was an American psychiatrist and educator. A native of Bridgeport, Connecticut, he earned both his undergraduate and medical degrees from Yale University. After receiving his M.D. in 1932, he began a career in the New York state psychiatric system, culminating in the directorship of Pilgrim Psychiatric Center in Brentwood, NY from 1958 to 1976. At its height in the mid-1950s, Pilgrim was the largest mental institution in the world, with a census of 13,875 patients. Brill also served as Deputy Commissioner of the New York State Department of Mental Hygiene from 1959 to 1964.

Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network. She is a prominent critic of the modern 'psychopharmacological' model of mental disorder and drug treatment, and the role of the pharmaceutical industry. She has written papers, books and blogs on the use and over-use of drug treatment for mental health problems, the mechanism of action of psychiatric drugs, their subjective and psychoactive effects, the history of drug treatment, and the evidence for its benefits and harms. She also writes on the history and politics of psychiatry more generally. Her best known books are The Myth of the Chemical Cure and The Bitterest Pills.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

Homosexuality was classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) beginning with the first edition, published in 1952 by the American Psychiatric Association (APA). This classification was challenged by gay rights activists in the years following the 1969 Stonewall riots, and in December 1973, the APA board of trustees voted to declassify homosexuality as a mental disorder. In 1974, the DSM was updated and homosexuality was replaced with a new diagnostic code for individuals distressed by their homosexuality. Distress over one's sexual orientation remained in the manual, under different names, until the DSM-5 in 2013.

Barry K. Herman Medical doctor in the United States of America

Barry Keith Herman is an American board certified adult and child and adolescent psychiatrist, psychiatric administrator, and physician executive. He currently is Chief Medical Officer of Atentiv Health, a digital health specialty provider, since March, 2020. Immediately prior, he was Senior Vice President and Chief Medical Officer of Tris Pharmaceuticals, Inc. in Monmouth Junction, NJ. He left this position at Tris in January 2020. Herman's interests include psychiatric administration and management, healthcare policy, and psychopharmacological research. He has spoken and written frequently on the topic of physician leadership and management. He is the author of over 100 scientific abstracts and manuscripts, and is frequently quoted in the media. His psychiatric research has been widely cited. Herman is the Past President of the American Association of Psychiatric Administrators, and currently serves on its Executive Council. He is the recipient of the 2017 American Psychiatric Association Administrative Psychiatry Award.

References

Footnotes

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  6. 1 2 3 "Return of Organization Exempt from Income Tax". American Psychiatric Association. Guidestar. December 31, 2016.
  7. 1 2 "About APA". psychiatry.org. Retrieved March 31, 2022. APA has more than 37,400 members involved in psychiatric practice, research, and academia representing the diversity of the patients for whom they care.
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  11. 1 2 Barton 1987, p. 168.
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  46. Viñas, Maria José (January 8, 2008). "Stanford Researcher, Accused of Conflicts, Steps Down as NIH Principal Investigator". The Chronicle of Higher Education .
  47. "APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry". psychiatry.org.

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