American Psychiatric Association
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 guide for diagnosing disorders.
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The American Psychiatric Association and the American Psychological Association (both known by the acronym APA) are sometimes distinguished as "the little APA" (American Psychiatric Association) and "the big APA" (American Psychological Association).
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.
In 1893, the organization changed its name to The American Medico-Psychological Association. In 1921, the Association changed that name to the present American Psychiatric Association. The Association was incorporated in 1927.
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. The seal has undergone several changes since that time.
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 M.D. are below the picture.
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.
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.
Development of the DSMEdit
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 494 pages long, including 265 diagnostic categories, 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. DSM-5 was published on May 18, 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 membershipEdit
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.
Publications and campaignsEdit
APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news.
Top five Choosing Wisely recommendationsEdit
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.
- Jeffrey Lieberman was the principal investigator for the Clinical Antipsychotic Trials of Intervention Effectiveness, sponsored by the National Institute of Mental Health study. He was President of the American Psychiatric Association in 2013–2014.
- Adolf Meyer was the president of the American Psychiatric Association from 1927–1928 and was one of the most influential figures in psychiatry in the first half of the twentieth century.
- Robert Spitzer was the chair of the task force of the third edition of the DSM.
- Herb Pardes past president and noted figure in American psychiatry.
Drug company tiesEdit
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.
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.
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 as to the nature of psychiatric illness and its treatment, as well as the relationship of mental health concerns to those of the community more broadly. 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 to torture detainees. 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."
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, 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 2009–10, Alan Schatzberg, also came under fire after he 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 himself created and in which he had several millions of dollars' worth of stock.
- "American Psychiatric Association". 2012. Retrieved 5 March 2012.
Representing 36,000 physician leaders in mental health.
- "Board of Trustees". American Psychiatric Association. American Psychiatric Association. Retrieved 2017-07-03.
- "Contact Us". American Psychiatric Association. Retrieved on September 6, 2012. "American Psychiatric Association 1000 Wilson Boulevard Suite 1825 Arlington, VA 22209"
- Moffic, H Steven. (2013). "Can the Name of an Organization Be an Ethical Issue?". Journal of Psychiatric Administration and Management. Nova Science Publishers, Inc. 2 (1). Retrieved 9 July 2016.
- "The Original Thirteen (preview)". Hospital & Community Psychiatry. Retrieved 24 September 2016.
- Barton, p. 89
- Barton, p. 168
- Ozarin, Lucy D. (April 17, 1998). Ramchandam, Dilip, ed. "History Notes: The Official Seal of the APA". Psychiatric News. American Psychiatric Association. Retrieved October 20, 2017. Archived August 29, 2008, at the Wayback Machine.
- "American Psychiatric Association Logo" (JPEG). University of California, San Francisco. Retrieved October 20, 2017. Archived October 20, 2017, at the Wayback Machine.
- Moran, Mike (May 28, 2015). "New APA Logo Unifies Image of Psychiatry". Psychiatric News. American Psychiatric Association. Retrieved October 20, 2017.
- Hausman, Ken (June 21, 2002). "Assembly Debates Name Change, Responds to Prescribing Law". Psychiatric News. American Psychiatric Association. p. 6. Archived from the original on October 13, 2004. Retrieved July 18, 2017.
- "Gay DC psychiatrist Saul Levin named head of APA". Washington Blade. Archived from the original on 21 April 2016. Retrieved 15 May 2016.
- "About APA". American Psychiatric Association. Archived from the original on December 6, 2006. Retrieved December 7, 2006.
- "DB Listing". American Psychiatric Association. 2011. Retrieved 5 March 2012.
- APA Policy Finder
- "Connect with us!". psychiatryonline.org. Retrieved 15 May 2016.
- "APA Releases List of Common Uses of Psychiatric Medications to Question" (PDF) (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 (20): 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. 342: 1539–1544. doi:10.1056/NEJM200005183422024. PMID 10816196. Retrieved October 4, 2010.
- Rothman, David (April 27, 2000). "Medical Professionalism — Focusing on the Real Issues". The New England Journal of Medicine. 342: 1284–1286. 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 April 25, 2011. Retrieved October 10, 2010.
- Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. p. 217.
- Friedman, Richard A. (May 23, 2011). "How a Telescopic Lens Muddles Psychiatric Insights". The New York Times. Retrieved 2011-05-24.
- "LBJ Fit to Serve". Associated Press. May 23, 1968. Retrieved 2011-05-24 – via Google News.
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 ...
- "American Psychiatric Association Statement on Diagnosis and Treatment Of Mental Disorders" (PDF) (Press release). American Psychiatric Association. 2003-09-25. Archived from the original (pdf) on 2007-06-14. Retrieved 2008-11-21.
- E.W. (July 28, 2015). "How America's psychologists ended up endorsing torture". The Economist. Washington, DC. Retrieved July 18, 2017.
- "Psychiatric Participation in Interrogation* of Detainees" (PDF). psych.org. American Psychiatric Association. Archived from the original (PDF) on June 22, 2006. Retrieved July 18, 2017.
- Sharfstein, Steven S. (August 19, 2005). "Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly". Psychiatric News. 40 (16). American Psychiatric Association. p. 3. Archived from the original on June 21, 2006. Retrieved July 18, 2017.
- Carey, Benedict; Harris, Gardiner (2008-07-12). "Psychiatric Group Faces Scrutiny Over Drug Industry Ties". The New York Times.
- Viñas, Maria José (2008-01-08). "Stanford Researcher, Accused of Conflicts, Steps Down as NIH Principal Investigator". The Chronicle of Higher Education.
- Official website
- Paul Lowinger papers, Kislak Center for Special Collections, Rare Books and Manuscripts, University of Pennsylvania. Paul Lowinger was a psychiatrist and founder of the Institute of Social Medicine and Community Health, and his papers are largely concerned with his work as a psychiatrist and activist, with significant portions devoted to his work with the American Psychiatric Association.