{"id":719,"date":"2013-06-06T01:27:42","date_gmt":"2013-06-06T08:27:42","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=719"},"modified":"2013-06-06T08:17:35","modified_gmt":"2013-06-06T15:17:35","slug":"the-apa-annual-meeting-a-photo-essay","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=719","title":{"rendered":"The APA annual meeting: a photo essay"},"content":{"rendered":"

\"MosconeCenter\"<\/a>As posted previously<\/a>, last month I attended the American Psychiatric Association’s (APA’s) annual conference. \u00a0Straying from my usual format, I thought I’d post pictures from the meeting and, of course, offer comments. The meeting took place in Moscone Center, a conference center complex located just south of Market Street in downtown San Francisco. \u00a0Depicted here are anti-psychiatry protesters who held a rally in front of the main entrance at noon on the first day. \u00a0There was also an exhibit of psychiatry’s cruelties (psychosurgery, shock treatment, inhumane conditions in asylums, etc) running all five days in a tent across the street from the conference. \u00a0\"GamelanConcert\"<\/a><\/p>\n

The conference was also a block from Yerba Buena Gardens, where I caught a very pleasant Balinese gamelan concert at the same time as the protest rally. This simultaneity \u2014 two events scheduled to coincide, forcing a choice \u2014 was a constant in the conference as well.\u00a0The “scientific program” consisted of \u00a0numerous overlapping talks, such that attending any presentation meant missing five or more other good ones. \u00a0I’m not sure why the APA opted for such frustrating redundancy. \u00a0Nor can I explain why predictably popular talks were scheduled into small rooms, with the result that dozens of registrants were turned away once the room filled. \u00a0For instance, the crowd for Otto Kernberg’s psychoanalytic talk on love and aggression was several times larger than the assigned room.\"KernbergAt<\/a> \u00a0In this unusual case we were all moved to a cavernous hall at the last moment, where Dr. Kernberg gave a warm and very engaging presentation on the necessity and creative consequences of aggression in romantic love. \u00a0(I like how this photo depicts the renowned psychoanalyst Kernberg representing the APA in an era of biological ascendancy.)<\/p>\n

The same huge auditorium was to hold the keynote address by Bill Clinton. \u00a0However, Mr. Clinton was ill and could not be there in person. \u00a0Several hundred (a couple thousand?) conference-goers nonetheless waited over an hour to see him on video. \u00a0Mr. Clinton was pleasant, thoughtful, and charismatic, but didn’t offer much specifically about psychiatry or mental health.\"ClintonCrowd\"<\/a>\u00a0 Mostly he spoke about public health needs in general.<\/p>\n

I didn’t take many photos in the talks themselves. \u00a0Officially it was forbidden, although this rule was routinely ignored by attendees. \u00a0The quality of the presentations was high \u2014 I mostly chose “mainstream” ones this time, not the many off-beat and generally smaller meetings. \u00a0I attended presentations on suicide, personality disorders, PTSD, sexual compulsions, DSM-5 and mood disorders, the controversy over antidepressant efficacy, psychiatrists writing and blogging for the general public, teaching psychotherapy to residents, and assessing the capacity of demented patients to make medical decisions for themselves. \u00a0There were dozens of others I would have liked to attend, had they not coincided with the ones I chose.<\/p>\n

I skipped the industry-sponsored, free lunch or dinner, non-CME presentations. \u00a0But I did wander through the exhibit hall, both to see the “new investigator” scientific posters, and to peruse the brand-new DSM-5. In contrast to the last time I went to this conference, the industry booths seemed less garish and “over the top.”\"APAexhibits\"<\/a> \u00a0Of course, there were still a lot of them. \u00a0Several had raffles where valuable prizes such as an iPad Mini could be won by those who gave the company their contact information. \u00a0One booth offered a pocket digest of the new DSM-5, MSRP about $60, to everyone who watched a 12 minute presentation and coughed up a mailing address. \u00a0I was tempted… but no. \u00a0(It’s interesting to ponder how much a single psychiatrist contact is worth to a drug company. \u00a0Much more than $60, I’d venture.)<\/p>\n

The DSM-5 itself is $200 in hardcover, $150 in paperback \u2014 an unabashed moneymaker for the APA. \u00a0Despite the incredible controversy it stirred up, my impression is that the changes from DSM-IV-TR are relatively minor. \u00a0In particular, the personality disorder section hasn’t changed much, although the new edition is no longer multi-axial, i.e., there is no “Axis 2”. \u00a0Some language has been made more precise, as well as more “biological” in some passages, and some disorders have been expanded to include more that would previously have been considered normal. \u00a0Whether this is good or bad depends on one’s perspective in several respects; mostly I find it unfortunate. \u00a0DSM classifications often matter more<\/a> to insurers and disability officers than to practicing psychiatrists, who in David Brooks’ words are “heroes of uncertainty<\/a>” (echoing an earlier post<\/a> of mine, but I’ll forgive him for not quoting me). \u00a0We deal with individuals, not disease categories.\"NoAveragePatient\"<\/a><\/p>\n

I will end with a slide from the talk on antidepressant efficacy that summarizes this tension in my field. \u00a0As I’ve discussed<\/a> previously, randomized controlled trials (RCTs) are the gold standard for scientific rigor in psychiatry; however, a lot of psychiatry is not scientific in this sense. \u00a0DSM categories help define the “average” patient with a particular disorder, leaving a lot of wiggle room since the categories are not based on etiology. \u00a0RCTs say which treatments best help this “average” patient, represented by the computer composite in the center of this slide. \u00a0However, I don’t see “average” patients, \u00a0I see one of the 12 individuals who contributed to the composite. \u00a0Thus, for me, the new DSM was a sideshow at the conference. \u00a0The most insightful presentations, whether on PTSD, suicide, or capacity assessment, combined science and the nuanced human communication of meaning. \u00a0They recognized that our work is informed by science but goes well beyond it. \u00a0Anti-psychiatrists don’t like this, insurers don’t like this, neuroscientists don’t like this, even many psychiatrists don’t like this. \u00a0But it’s true and inevitable for the foreseeable future. \u00a0I like it. \u00a0As for the APA annual meeting, I’m glad I went, and equally glad I won’t feel the need to go back for several years at least.<\/p>\n","protected":false},"excerpt":{"rendered":"

As posted previously, last month I attended the American Psychiatric Association’s (APA’s) annual conference. Straying from my usual format, I thought I’d post pictures from the meeting and, of course, offer comments. The meeting took place in Moscone Center, a conference center complex located just south of Market Street in downtown San Francisco. Depicted here […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,51],"tags":[11,46,16,45,43],"class_list":["post-719","post","type-post","status-publish","format-standard","hentry","category-current-events","category-psychiatry-in-general","tag-cme","tag-nomothetic-vs-idiographic","tag-pharmaceutical-marketing","tag-psychiatric-research","tag-uncertainty","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/719","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=719"}],"version-history":[{"count":29,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/719\/revisions"}],"predecessor-version":[{"id":755,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/719\/revisions\/755"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=719"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=719"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=719"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}