Medical students with an interest in public health and political activism are being introduced to community psychiatry through an innovative liaison project between the American Association of Community Psychiatry (AACP) and the American Medical Students Association (AMSA).

"Medical students in AMSA are very involved in issues related to social responsibility and medicine," said AACP member Kenneth Thompson, M.D., director of the Institute on Public Health and Psychiatry, who conceived the idea of a liaison between the two groups. "But they are largely disconnected from psychiatry because psychiatrists--and organized psychiatry--have not made an effort to interface with those students around the issues they are concerned about," he said.

Addiction, homelessness, violence, and crime--these are the issues that community psychiatry and AMSA are both concerned about, Thompson told Psychiatric News, so a partnership between the two organizations is only natural.

Thompson said the liaison project is supported by a grant of $2,000 to the AACP from the Maurice Falk Medical Fund.

Alex Isaac, a third-year student at Chicago Medical School, and Gary Lubow, of Ohio State University School of Medicine, are serving as student liaisons between the two organizations, helping to generate interest in community psychiatry at the medical student level.

In an article he penned for an AMSA journal on the commitment of medical students to social justice, Isaac cited the 19th century physician Rudolf Karl Virchow--who wrote once that "politics is medicine on a grand scale"--in a statement that may resonate with psychiatrists inside and outside of community psychiatry.

Isaac wrote: "If the economic interests of the insurance companies and the market interests of HMO shareholders continue to define health care policy, we will see in painfully clear light what Virchow told us 150 years ago, [that] health care may be a commodity to be distributed within society like wealth and opportunity, but disease is more democratic."

Drawing again on Virchow, Isaac wrote that there are four principles of medical reform: the health of the people is a matter of direct social concern; social and economic conditions have an important effect on health and disease, and these relations must be investigated scientifically; measures taken to promote health and combat disease must be social as well as medical; and medical statistics must be our standard of measurement.

In interviews with Psychiatric News, the two students said the liaison position fills a void in the exposure of medical students to psychiatry in general and to community psychiatry in particular.

Isaac said this void was made particularly dramatic during the 1995 National Primary Health Care Day--an event sponsored by the American Association of Medical Colleges and supported by a variety of physician groups--when, he said, there was not one psychiatrist participating.

In the same AMSA journal article, Isaac alerts psychiatrists to the upcoming 1996 National Primary Health Care Day in Chicago with the following admonition: "Go to the psychiatry departments of the medical schools nearby and ask them if they have ever heard of National Primary Health Care Day. When they say no, ask them why they didn't think of it in the first place. Use this event as an entree to student groups where there will be many opportunities to expose students to your work and your beliefs. It is important to identify interested students in their first or second year before they are acculturated to mainstream, nine-to-five medical values."

Uphill Battle
Attracting the interest of their peers in community psychiatry or in social activism is, however, generally an uphill battle, Isaac and Lubow say.

The two students testified to what every physician knows: that the rigors of medical education leave scant time or energy for anything but academic success--and next to no time for social or political activism.

And both said that the hierarchical nature of medical institutions--indeed, the medical school experience itself--works to grind down those students who seek to apply their medical skills to coping with social problems.

As student liaisons, Isaac and Lubow work to ensure the availability of community psychiatry speakers and contact people across the country for AMSA meetings and other groups planning community health-related events.

They also attend the yearly national conferences of both organizations and act as a contact between area community psychiatrists and the medical school psychiatry service to enable students interested in community psychiatry to get exposure via electives or clerkships.

Inspiration and Action
Thompson, of the AACP, said he remembers AMSA and its commitment from his own days as a medical student.

"I was involved in AMSA in medical school and found it to be a great source of inspiration and action," Thompson told Psychiatric News, "especially regarding community health and social activism, taking care of people who were ill but on the margins.

"When I got in to psychiatry, my contacts with AMSA disappeared and I realized that there had been no psychiatrists who had been actively involved in the organization," he said.

Since community psychiatry "really predates the community health movement, I thought it was foolish that we were not more involved," he said.

Isaac and Lubow agree with Thompson that the most pressing social ills in America today--violence, drug and alcohol abuse, homelessness, and crime--are ripe for intervention by psychiatrists. "I think it is a responsibility of psychiatry to be producing interventions for these illnesses," said Lubow.

Isaac also said he sees the liaison project as critical for the future health and viability of psychiatry. "Invest in the future," Isaac advised psychiatrists. "As managed care grows and more and more patients are disenfranchised, there will be major social problems. Psychiatry has a role because mental illness and poverty are so clearly related."

And he urged psychiatrists not to rely on institutional structures, including APA, but to strike out on their own.

"Go to the local medical school and sell psychiatry to medical students," Isaac advised. "Don't be afraid to take a stand on some radical old ground."

(Psychiatric News, September 6, 1996)