To The Point

With this issue of the Journal, WSPA begins a new offering in the newsletter entitled, To The Point. This is an opportunity for WSPA members to present their opinions on issues that are current and relevant to psychiatry both nationally and within Washington.

The Issue: Should The APA Be Taking Positions on Political and Social Matters?

Dr. Rob Williams wrote in the Summer 2007 Issue of WSPA Journal:

An APA president needs to be careful to draw a clear distinction between personal opinion and official APA positions, but we also vote for leadership when we choose a president and a president should provide a sense of vision for the organization. Regarding the assertion that the APA should not be “taking positions on political and social matters (especially controversial ones),” I strongly disagree for several reasons.

First: APA is a professional organization. Professional organizations represent not only the members; they also represent the standards and science of the profession. Society justifiably looks to professional organizations like the APA for guidance and leadership, especially when society is at crossroads regarding decisions on controversial issues. If we (APA) want to claim the mantle of authority of representing the profession of psychiatry then we must accept the responsibility that comes with that claim. To evade this responsibility would be unethical. Official positions should always reflect the best scientific information available at the time. That some (or even most) members might hold personal, political, or religious viewpoints which are not consistent with the current scientific data or ethical standards does not mean that the organization should be constrained by those viewpoints in taking official positions.

Second: Who decides what is too political or controversial? Based on current science, the connection between discrimination and bigotry and individual mental health is not at all controversial. Thus, APA taking a position on marriage equality for gay couples is completely appropriate. This involves not just the mental health of gay patients (though this would be ample justification), but also the health and safety of their families. The controversy here is in reconciling science with culturally tolerated unscientific belief systems. APA represents science based beliefs. My guess is that many would have no problem with the APA, AMA, or other medical organization taking a position on tort and malpractice reform, though this is clearly political and controversial. And the “science” regarding that issue and patient care or member interests is very limited and inconclusive.

Third: Regarding alienating members, I would guess that at least an equal number of members would be (or have been) alienated by the APA refusing to take position on certain controversial issues. Of note, despite numerous threats of defections, the APA membership has actually increased since its taking a position on equal marriage rights. Those who benefit from the status quo are often incensed by challenges to the status quo.

Fourth: Like no other medical profession, psychiatry operates in the interface between the individual and society and culture. Cultural and social issues are inextricable from psychiatry. To claim there can be a clear boundary would be naïve or disingenuous.

Rebuttal by H B Edwards, MD:

Regarding your article in the newsletter: Would you have supported APA weighing in on such issues if they were opposed to same sex marriage?

BTW: While I consider my sexual orientation to be private, not something the APA needs to know, my partner and I find ourselves in the odd position of being unable to take advantage of some of privileges accorded same sex partners until we (or I?) reach age 62 under the new WA law. Doesn’t that constitute discrimination on the basis of sexual orientation and/or age? Should APA go to bat for us?

As for the “science” involved. I’m sure many kinds of discrimination, lawful and otherwise, have an emotional impact on the “victims” but I doubt it actually causes any mental disorder. On the other hand you could easily argue that armed conflict causes PTSD. Should APA oppose military service? American involvement in armed conflict? Should APA join the NRA in assuring access to firearms for self defense so our patients won’t be victims of abusers and stalkers? Where does it all stop? I don’t even like the idea of Sharfstein advocating for a single payer system in the name of APA. How do we know it will be better for our patients? And it may be good for some members and bad for others.