American Psychiatric Association

The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 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 world-wide 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.

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), which later became the American Psychiatric Association in 1921. The group included Thomas Kirkbride creator of the asylum model which was used throughout the United States.

The Association was Incorporated in the District of Columbia in 1927.

The APA emblem, dating to 1890, became more officially adopted from 1921 - 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.

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 a DSM-V planned for around 2011.

The assembly membership voted against a further proposed name change in 2002, to the American Psychiatric Medical Association amidst increasing concern to differentiate themselves from clinical psychologists.

Organization and Membership
APA is led by a President (currently Pedro Ruiz) and a Board of Trustees with an Executive Committee.

APA reports 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

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 and practice guidelines and description of its core diagnostic manual the DSM are published.

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

APA recently launched a health campaign with a new PR approach

Notable figures

 * Adolf Meyer rose to prominence as the president of the American Psychiatric Association and was one of the most influential figures in psychiatry in the first half of the twentieth century.


 * Robert Spitzer was a key figure in the development of later editions of the DSM.


 * Donald Ewen Cameron is best known for his mind and behavior controlling work for the CIA. Cameron was President of the APA in 1952-1953.

Controversies
Controversies have related to Anti-psychiatry and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. 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.

In the late 1960s and 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 small 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 homosexuality", which was later dropped. Some controversy still remains regarding the 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".

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 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 president caused controversy in 2005 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.