President?s column

A big step backward

By Martin E.P. Seligman, PhD
APA President

Donald Klein, MD, and I had a dream. It started as a public argument between us on the Internet about whether drugs or psychotherapy was the treatment of choice for panic disorder. Out of this argument arose our dream: that APA and the American Psychiatric Association would collaborate on an electronic journal that would become the medium of such dialogue between psychiatrists and psychologists. After two years of work?both political and intellectual?this became a reality, and the stegosaur and the tyrannosaur agreed to mate. Both organizations formally agreed to co-publish an electronic journal. The journal would publish breakthrough articles in psychotherapy and pharmacotherapy along with peer commentary.

We published our first article and commentary in September 1997. You can read it on the web at http://www.journals.apa.org/treatment.

The dream has ended. In December 1997 the American Psychiatric Association?s Board of Trustees, acting in a closed-door meeting, withdrew from the collaboration (see article on page 42). They cited the need for a ?broad review of the costs and benefits of electronic publishing projects.? This, of course, was not the whole story.

In August I began getting messages from their leadership that their board, led by the California trustees, might end their participation. In September, they put their cooperation on hold, citing the ?state of the relationship between the two associations.? I was informed that APA?s policy of seeking prescription privileges for psychologists was the central problem. What publishing this scholarly journal had to do with that issue was not clear, but we crafted a disclaimer that reading Treatment did not qualify one to prescribe. It was clear, however, that their final decision to end the collaboration was political. Many of their trustees were worried that any collaboration with APA would legitimize the efforts of psychologists to obtain prescription privileges.

A shameful decision
The American Psychiatric Association?s decision to end its participation in the journal Treatment is shameful. Collaboration among scientists, the rapid dissemination of knowledge of immediate benefit to patients, and the open exchange of ideas among scientists and practitioners?be they psychiatrists or psychologists?are high ideals. This is how progress in the treatment of mental illness can best occur. These ideals should not be sacrificed to political ambition or to squabbles between guilds about the scope of practice. The act of their trustees nullifies two years of dedicated work by the authors, publishing boards and editors from both organizations. It is a giant step backward from the improving relationship between the two largest mental health associations in America crafted under the leadership of Dorothy Cantor, PsyD, and Harold Eist, MD.

Treatment will continue. If APA?s Publications and Communication Board approves, it will become APA?s flagship electronic journal. Its new title will be Treatment and Prevention. It will continue to publish breakthrough articles in the areas of psychotherapy and medications. It will publish articles about prevention and about personality, as far as these are relevant to treatment. It will underscore the theme that interventions not only repair damage, but also build human strength. It will fill the gap created for clinical science by the narrow coverage of Science, Nature and The New England Journal of Medicine. It will also publish, with peer commentary, an electronic reprint of ?The Article of the Week,? selected by all APA editors, as the current article to be brought to the attention of the membership and the media. Treatment and Prevention will be free to all APA members, and you can subscribe at http:// www.journals.apa.org/treatment/subscribe.html.

Implications for the future
What of the future relations between the two organizations? I believe that while the actions of the American Psychiatric Association regarding Treatment are (I can find no gentler word) dishonorable, there are many issues on which we remain on the same sides of the barricades. Managed care, funding for science, and patient welfare are three examples. We must stand ready to be allies over these issues, and we must continue to hope that the American Psychiatric Association will come once again to stand with us for the open exchange of ideas in the promotion of science and patient welfare.