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

A Small Striking Committee

The assault on GAP by the Committee for the Preservation of Medical Standards in Psychiatry served to hasten the decision which the GAP membership had been rather reluctant to face:  Was their organization to continue indefinitely on a makeshift, temporary basis, or was it to reconstitute itself as a permanent group?  The experiences of the early years convinced most members that, notwithstanding the APA reforms and other gains, a  small Striking force for American psychiatry  could be of value for years to come.  In a communication addressed to the Commonwealth Fund in 1948, the underlying rationale for a GAP-type organization was restated in this wise:

It must be progressive.  It must be devoted and willing to spend many personal hours for the advancement of psychiatry....The size will determine its cohesiveness, flexibility and mobility.  It needs to be militant so that it may tackle problems of the day.  It must be small enough to mobilize quickly and to act promptly.  It must be willing to pioneer; to investigate and take action on the "neglected" areas concerned with psychiatry; to deal aggressively with the "hot potatoes."...Its membership must not only be willing to undertake the difficult, but they must be willing to sacrifice in time and money and energy to accomplish these aims.

GAP was incorporated in 1947, a step taken, as was carefully explained at the time, to facilitate the receipt of foundation grants.  In 1950 a GAP constitution was adopted.  This proved quite a stabilizing step for the youthful group--youthful in spite of the fact that some of the  Young Turks  of 1946 were already calling themselves  old goats.   For one thing, the constitution permitted an orderly change of GAP officers, relieving President William C. Menninger and Secretary Henry W. Brosin from an  enforced servitude  against which they had vigorously protested.  They had both been elected--drafted, rather--over their objections, year after year.  The constitution provided for the election of officers every two years, declaring the president ineligible to succeed himself for two years following his retirement.  While this prohibition did not obtain for the secretary-treasurer, Dr. Brosin seized the opportunity to retire with his teammate, Dr. Menninger, at the April, 1951, GAP meeting, when the constitution went into effect and new officers were chosen.  Dr. Jack R., Ewalt (now professor of psychiatry at Harvard University, director of the Massachusetts Mental Health Center, and also executive head of the Joint Commission on Mental Illness and Health) was elected president of GAP, and Malcolm J. Farrell, superintendent of the Walter E. Fernald School at Waverley, Massachusetts, secretary-treasurer.

Dr. Walter E. Barton, superintendent of the Boston State Hospital, was president in 1953-55; Dr. Sol W. Ginsburg, a psychoanalyst in private practice, 1955-57; and Dr. Dana L. Farnsworth, director of University Health Services at Harvard University, 1957-59.  Dr. Marion E. Kenworthy, professor emeritus of psychiatry at the New York School of Social Work and president of the American Psychoanalytic Association, succeeded Dr. Farnsworth in 1959.

Although often referred to as a  Young Turks  movement,  GAP from the first included in its membership a wide age-range of psychiatrists.  A statistical study of its membership was undertaken in 1950, revealing that the youngest member was aged twenty-eight, the eldest sixty-five, and the average forty-seven.  Three ex-presidents of the APA were among GAP's charter members, along with many heads of university departments, mental hospital superintendents, executives of state mental health departments, and directors of psychiatric research institutes.

While the membership roster of GAP does indeed include a great proportion of distinguished psychiatrists, it includes also a goodly number of younger  unknowns  of demonstrable ability.  If GAP is an organization of the  elites,  it is an elite of talent rather than reputation.

The uniqueness of GAP was well-stated in a communication to the Field Foundation in 1950, which declared:

GAP differs from other medical organizations in that (1) it consists of highly selected members on the basis of special abilities, all of whom work actively on some project; (2) the organization is not for the benefit of members; (3) the core of the organization is its working committees and not the administrative officers.

GAP is an experimental group, a loose federation of investigating committees, each with its own research and educational functions and goals.  Each explores pertinent ideas and methods of communication in its field.  The devotion of the committee members to their projects is illustrated by the fact that many of them have determined to continue their joint activities even if GAP as a whole cannot continue for lack of finances to hold two general meetings a year....

Because GAP committee work is creative and exerts widespread influence, we believe it is justified in requesting foundation support in the same sense that research projects are renewable as they develop new programs on the frontiers of knowledge.  Each committee is an investigative team equipped by the talent and interests of its members without regard to geography or social determinants to do a distinctive job which is highly desirable to further psychiatry and the progress of psychiatry and its allied disciplines.

This writer, who was privileged to sit in as a guest at one of the founding meetings in Chicago, and has since attended a number of GAP conferences as a consultant, can attest to the extraordinary degree of dedication as well as the democratic spirit that pervades the gatherings.

Asked for his observation on what makes GAP go, former President Dana L. Farnsworth says:

The beauty of GAP is mainly in its loose organization.  The committees practically run themselves.  Nobody can get pushed around.  The officers have no real power; they are more like errand boys.  I am sure that one vital reason why so many stay on and come to meetings regularly, and work between meetings, is this very informality--the knowledge that there is no pressure, that one may drop out at any time without traumatic explosions.  If we were to get too formalized, we'd break up.

As a matter of fact, it seemed during the first years that GAP might be stifled by the general reluctance of members to drop out and make room for fresher, younger blood.  Since membership was strictly limited, a danger loomed that the extraordinary dynamic quality of GAP might be vitiated by lack of circulation.  The problem was solved by developing a category of  contributing members,  whereby members who had served actively at least three years might retire to inactive status while still remaining GAP members.  Contributing members pay dues of $25 annually.  According to the latest available figures, there are now 189 active, 73 contributing, and 3  life  members (an honorary category now including Drs. Earl D. Bond, Bruce B. Robinson, and Arthur H. Ruggles).

At each GAP meeting, four selected residents in psychiatry attend and participate in committee sessions as invited guests, with their expenses paid by the host group.  Each one attends four successive meetings.  this provides a chance for men who are entering the profession to enjoy the stimulating and often inspirational fellowship of older men on a basis of equality.

GAP gives us all a chance to be among people who are interested in the same thing, and who are interesting people in their own right,  says Dr. Farnsworth.  Here is how he sums up GAP's significance to American psychiatry:

  1. GAP is small enough to get the real opinions of thoughtful people in the field.  These opinions are not watered down by excessive caution, such as is manifested so often in larger, more formalized groups.
  2. The body of GAP reports represents the summation, the distillation, of what is generally the best thinking being done collectively in any specific aspect of psychiatry.
  3. GAP presents a forum for the interchange of different approaches in a  disputatious atmosphere  where individuals can disagree openly and frankly with their peers without the threat to reputation, friendship, or self-esteem.
  4. GAP has demonstrated that it is an effective agency for harmonious interdisciplinary collaboration leading to action on common fronts of interest.  The psychiatrists and their cooperating consultants meet here as peers in a setting of equality.  Nobody pulls rank, regardless of profession, position, or reputation.

In GAP we are continually testing ideas on the advancing edge of psychiatry,  Dr. Farnsworth adds.

It is a unique experiment in collaborative thinking, this Group for the Advancement of Psychiatry.  Its further contributions will be followed eagerly by large numbers of persons outside GAP who are concerned with the application of modern knowledge of human behavior to the broader problems of society.

Albert Deutsch

The Financial History of GAP

The Financial history of GAP may be of interest to some readers.  A small assessment was made after the Chicago meeting to cover printing, postage, and other administrative charges.  Shortly afterwards, the Commonwealth Fund made a grant to support GAP for its first three or four years.  This money was used to cover the costs of meetings and publications and to defray in part the expense of travel.  With respect to this last item, the first fifty dollars of expense was paid by the members themselves, thus equalizing the cost of attendance for those members coming from great distances and those residing near the meeting place.

With the exhaustion of the Commonwealth Fund grant, GAP faced a financial crisis.  A Finance Committee, under the chairmanship of Dr. Jack R. Ewalt, was appointed to study the financial needs and resources of the organization.  As a result, grants were obtained from several other foundations--notably the Field Foundation and the New York Foundation.  In addition, more than $17,000 was pledged by the membership.  At this time, members voted to assess themselves $100 a year for dues and to drop the $50 deductible clause on the understanding that all members' expenses to the meetings would be paid for by the organization.  With continued support from foundations, GAP managed to operate more or less on this same basis.  In 1957 dues were raised to $150 a year.

GAP reports were originally distributed to interested persons free of charge and without limitation as to number.  They are now offered for sale on a cost-recovery basis, but subsidy is still needed to cover the expense of the research committee meetings and the immediate costs of publication.

Jack R. Ewalt, M.D.