Insight Matters
Winter 2006

Psychiatry in the Public Eye
 By David Bienenfeld, M.D., President

While most of us are careful to separate our political and social leanings from our practices of psychiatry, we cannot always separate our identities as psychiatrists from our roles as members of our communities. In our lives outside of work, our friends and neighbors will often identify each of us as “the psychiatrist.” Although no one of us can claim (or would want to) represent all our colleagues, what we do, and how we act, reflects on our profession to members of the lay public.

When any of us coaches her daughter’s soccer team, or raises funds for the art museum, it contributes to a benign image of a socially committed physician who puts his/her Hippocratic values to work outside the office as well. Easy enough, but… Sometimes a parent needs to raise a fuss over a teacher who is not performing up to expectations. Sometimes the off-duty psychiatrist needs to remind a parishioner that his/her dues are delinquent. How we conduct ourselves in situations of stress and conflict comes under scrutiny, and is held to a sometimes unrealistic standard of psychiatric equanimity.

Our social lives may also become political. Most of us have solid opinions about political issues, and some choose to be active as citizens, campaigning for particular candidates or issues. In this realm, we similarly cannot escape the broad brush. The psychiatrist who writes a letter to the editor of the local paper promoting a liberal agenda risks painting all of his/her colleagues as softies and bleeding hearts.

The American Psychiatric Association occasionally steps into this arena. There are public issues which may affect our patients or our practices, and APA has chosen at times to take position statements on such issues. For the most part, these positions represent a degree of advocacy about which there is clear consensus among the membership, but not always.

In 2005, the Assembly and the Board of Trustees passed a Position Statement entitled, “Support of Legal Recognition of Same-Sex Civil Marriage.” The title alone was enough to raise the ire of many members, including some members of OPA’s Council. Objections were raised that the position statement reflected the opinion of a vocal and influential core in the APA, but did not reflect a broad consensus of the membership. Further, the discomfort around this particular item raised the larger question of whether the APA has any business voicing opinions about divisive social and political issues.

In context, this Position Statement focuses on the psychological distress caused to same-sex partners by the lack of civil recognition. It also draws attention to the emotional impact on children of such partnerships. The Statement is consistent with a number of others dating back to 1973. Position Statements must make their way through the arcane structure of APA, and be passed by both the Assembly and the Board of Trustees, which presumably represent the membership. But such nuances are quickly lost when the topic is this heated.

I am personally ambivalent about what APA’s role should be in matters of public interest. We are indeed different from most of our other medical colleagues. Matters of social policy affect our patients clinically much more directly than they do surgical patients. Physicians are drawn to our specialty because of a strong affinity for human connections and dynamics, including social ones. Council similarly struggled with how to address APA and ensure that official stands reflect broadly held opinions of our membership. Our APA Representatives will voice our concerns and keep careful watch on issues as they rise to the surface of PA activity, so we can have more influence on what is said on our behalf.

To be your most effective advocates within our own parent organization, we should know how our membership feels. Does APA have an obligation, or even a right, to take stands on matters of public policy? Does doing so put our profession in too controversial a public light? Or does not doing so amount to default on our obligation to advocate for the needs and rights of our patients? Let us know what you think.

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