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The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 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, or DSM. The DSM codifies psychiatric conditions and is used worldwide as a key guide to diagnosing disorders.

The abbreviation 'APA' is also in common and similar usage by the American Psychological Association and their 'APA style guide' for journal articles.

Contents

History

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."[1]

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.[2] 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, planned for 2012.

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. Nowadays the research and clinical literature demonstrate that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality and the longstanding consensus of the behavioral and social sciences and the health and mental health professions is that homosexuality per se is a normal and positive variation of human sexual orientation.[3][4]

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.[5]

Organization and Membership

APA is led by a President and a Board of Trustees with an Executive Committee.

APA reports [6] that its membership is comprised primarily of 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 75 district associations throughout the US.[7]

Theoretical Position

APA can generally be considered to reflect mainstream, particularly US, psychiatry. In the past it has been predominantly associated with psychodynamic approaches, or the approach exemplified by Adolf Meyer, but more recently has become more associated with a biomedical approach also known as biopsychiatry.

The DSM is currently intended to be atheoretical, 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 position statements,[8] Psych.org and practice guidelines[9] and description of its core diagnostic manual the DSM [10] are published.

APA publishes several journals[11] focused on different areas of psychiatry, for example, academic, clinical practice, or news.

APA recently launched a health campaign[12] with a new PR approach[13]

Notable figures

Controversies

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[14] 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 [15] 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.[16]

The APA president in 2005, 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.[17] 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.[18] The current APA president elect, Alan Schatzberg, has also come under fire after it came to light that he was principal investigator on a federal study into a drug being developed by Corcept Therapeutics, a company Schatzberg had himself set up and in which he had several millions of dollars’ worth of stock.[19]

See also

References

  1. ^ "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. http://www.psychservices.psychiatryonline.org/cgi/content/full/56/12/1621-a. Retrieved 2009-08-07.  
  2. ^ http://www.psych.org/pnews/98-04-17/hx.html
  3. ^ American Psychological Association: Appropriate Therapeutic Responses to Sexual Orientation
  4. ^ Royal College of Psychiatrists: Submission to the Church of England’s Listening Exercise on Human Sexuality.
  5. ^ "Assembly Debates Name Change, Responds to Prescribing Law - Hausman 37 (12): 6 - Psychiatr News". Pn.psychiatryonline.org. 2002-06-21. http://pn.psychiatryonline.org/cgi/content/full/37/12/6. Retrieved 2009-08-07.  
  6. ^ http://www.psych.org/about_apa/
  7. ^ http://www.psych.org/dbs_state_soc/db_list/db_info_dyn.cfm
  8. ^ Position Statements
  9. ^ Practice guidelines Practice Guidelines, Psych.org
  10. ^ DSM - Diagnostic and Statistical Manual of Mental Disorders
  11. ^ psychiatryonline.org
  12. ^ HealthyMinds.org
  13. ^ Michelle Riba. APA Offers New Perspective On Psychiatry and Mental Illness, Psychiatric News , April 1, 2005
  14. ^ American Psychiatric Association (2003-09-25). "American Psychiatric Association Statement on Diagnosis and Treatment Of Mental Disorders" (pdf). Press release. Archived from the original on 2004-06-13. http://web.archive.org/web/20070614091656/http://www.psych.org/news_room/press_releases/mentaldisorders0339.pdf. Retrieved 2008-11-21.  
  15. ^ Psychiatric participation in interrogation of detainees
  16. ^ Controversy Continues to Grow Over DSM’s GID Diagnosis
  17. ^ Sharfstein, SS. (2005) Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly Psychiatric News August 19, 2005 Volume 40 Number 16
  18. ^ Psychiatric Group Faces Scrutiny Over Drug Industry Ties, New York Times, 2008-07-12
  19. ^ Stanford Researcher, Accused of Conflicts, Steps Down as NIH Principal Investigator, The Chronicle of Higher Education, 2008-01-08

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