Group for the Advancement of Psychiatry - The Story of GAP

Table of Contents

Introduction
The Story of Gap
Postwar Challenge
Gap is Organized
Basis for Action
 No Auditors Needed
APA Reforms
Light on the Law
Psychiatry and Socials Issues
Child Psychiatry
Brain Surgery
International Relations
Federal Agencies
Medical Education
Industry
How Reports are Processed
Influence Abroad
Gap Symposia
Statements on Current Issues
Mental Health Campaign
The Essence of Gap
The Attack on Gap
A Small Striking Committee
The Financial History of Gap

 

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.