Chapter 4
The APA - From Humanitarian Concerns to Science to Advocacy
Throughout the history of humanity, some have devoted their lives to those who need help, some have made money out of them, and many have been indifferent.
The former CEO of a large insurance company was recently asked whether he considered it unethical to have received a salary of more than 6 million dollars a year while his company was curtailing treatment for the sick. He saw no problem: the company was growing, the shareholders were satisfied, and his salary was a reflection of the market forces...which did not include the health of those covered by his "insurance".
The CEO's attitude reflects the distortion resulting when the supposedly insured person has no say on the protection she may or may not receive, and the business of the company is predicated on extracting more money from more people, regardless of the services provided or not provided.
There seems to be no room for humanitarian concerns in the atmosphere of shareholders and profits. These concerns have traditionally guided those who allow their compassion and their sense of human value to direct their actions.
The forerunner of the American Psychiatric Association emerged in 1844 as the joint effort of physicians who had devoted their lives to the care of the mentally ill. Diagnostic and therapeutic tools were then almost non-existent, so the physicians' effort were for the most part directed toward assuring humane care for the mentally ill. This situation continued in about the same condition until the emergence of a more scientific medicine half a century later.
A cascade of events brought a great deal of science into psychiatry in the first part of the 20th century. Paul Dudley White's skillful use of the EKG as a research tool led to the separation of anxiety disorders from organic heart conditions.(6) The same researchers who worked with Dr. White in learning about diagnostic criteria, laboratory findings and family characteristics in anxiety disorders, were the teachers of those who created research-based diagnoses in psychiatry early in the second half of this century. In the second part of the 20th Century, the APA became a center for the best research in the diagnosis and treatment of psychiatric disorders. It also became one of the five largest medical associations in the USA.
A long history of humanitarian endeavors, many scientific achievements, and the loyalty of the overwhelming majority of the psychiatrists in the USA did not prepare the American Psychiatric Association to face the threats presented by the emergence of the managed care companies. These companies threatened to destroy the profession by preventing physicians from treating their patients.
When the managed care companies started to assert themselves as the controlling force in health care, the physicians affected had many reactions, varying from joining the companies, to starting immediate and vigorous opposition. Ensuing chapters deal with these reactions and with the movement toward patient advocacy.
©2000 Munoz and Eist, The People v. Managed Care