Organized psychiatry and psychology, stern adversaries at the national organizational level in recent years, may be embarking on an armistice.

Or so it would appear from an unprecedented meeting between leaders of the American Psychological Association and APA President Harold Eist, M.D., at last month's annual meeting of the psychological association in Toronto, Ont.

Eist and Dorothy Cantor, Ph.D., president of the American Psychological Association, shared the podium in the joint "Dialogue Between the American Psychological Association and the American Psychiatric Association Toward Developing a Common Agenda in Service of the Public."

Eist and Cantor vowed to leave the guild and turf battles of recent years behind in the name of fighting a common enemy: managed care.

Both presidents stressed common achievements, especially the Patient Bill of Rights; vowed future meetings and further collaboration in the fight against managed care; and challenged each other to raise money to fund public awareness and other campaigns against managed care.

Eist said that this month APA, the American Psychological Association, and a coalition of other health and mental health advocacy organizations would be meeting to fine-tune the Patient Bill of Rights.

"And then we are going to proceed as a half-million-strong coalition fighting for parity," Eist said, "not wasting resources fighting each other, not exhausting ourselves with the divide-and-conquer [strategy] that others would like us to do."

Cantor concurred that the two organizations have more to gain by working together than fighting each other.

"I think what has happened up to now is that the health care industry has seen our arguments as a way of keeping us apart and fighting with each other so that we won't look after the welfare of our patients and so that [the managed care industry] can get away with murder," Cantor said.

In an oblique reference to ongoing efforts by state psychological organizations to obtain pharmaceutical prescribing privileges, Cantor said that some turf battles between psychiatry and psychology will be inevitable, but that they need not deter the two national organizations from working together in the interest of patient care.

"There are legislative initiatives that have been introduced in various states that may_not may, will_still be in that baggage," she said. "It would be unrealistic to think that because we are [talking together at this meeting and fighting managed care together], that isn't going to happen. . . . I would just as soon leave that bag where it is, let the fighting go on where it may, but make it clear to the managed care companies that just because that is going on doesn't mean a hill of beans because when it comes to managed care, we are all reading from the same document."

Eist, not known for being oblique, took the cue to address the subject head on.

"Let's talk about prescribing privileges," he said. "Go ahead! Let's get into a war over prescribing privileges. Let's tax our members millions and millions of dollars over prescribing privileges. Let's kill each other! And you win! You get prescribing privileges! What are you going to do with 'em? By the time you win that battle, it won't do you any good.

"It's stupid for us to be fighting each other," Eist said. Guild Issues

Eist said recriminations over guild issues are likely to endure, but he seemed to refer to the prescribing issue_having been resolved at the national level, for the time being, with the termination of the Department of Defense's military psychologist prescribing program_as a bygone one.

"There are going to be some continuing reverberations from some of these battles," he said. "They may last until some of the people who have been involved in the battles die off. And because we seem to have long memories on both sides for narcissistic injuries, insults, for pecking order stuff . . .Dorothy is probably right_we will have naysayers on both sides for some time to come."

But Eist said the opportunities for partnership between APA and the psychological association are many.

He cited the joint electronic journal_an online research publication to be jointly produced by the American Psychiatric Association and the psychological association_as one hard-fought achievement of the two organizations.

Eist also vowed to raise the possibility of having a joint session or symposium with psychologists at APA's annual meeting next year in San Diego. "I'd like to see all of you in San Diego," Eist said.

The APA president also told the psychologists that he has fought to keep APA's Institute on Psychiatric Services, an interdisciplinary meeting, on the Association schedule. Scorched Earth

Eist's words about managed care at the psychological association meeting seemed more forceful than ever. He told the psychologists that APA maintains a litigation fund for fighting managed care in the courts, and he called for a "scorched-earth litigation" strategy.

"There is no free market in health care," he said. "We have an imprisoned market controlled by fewer and fewer big players operating exactly like totalitarian states with gag clauses, dismiss-without-cause clauses, and appeals processes that would warm the cockles of Machiavelli's heart.

"Whole neighborhoods and large numbers of professionals are being redlined," Eist continued. "American health care is being organized precisely in the manner of the cartels of Nazi Germany, Japan, and fascist Italy prior to World War II."

Eist drew a parallel between the "vertical and horizontal integration" of Japanese business and industry prior to World War II and the calls for integration of health care systems in America today.

"Currently, corporations in America are heading toward vertical and horizontal integration, which are the excited buzzwords of overzealous entrepreneurs," Eist said. "Their eyes flash when they talk about it, their mouths water. . . . Nowhere is this totalitarian mood more aggressive and arrogant than in health care, with seriously little public awareness and debate.

"Clearly, a scorched-earth litigation strategy is indicated," Eist said. "It is necessary to inform the public of what is happening, put the government on notice, and inspire our members to block totalitarianism in health care_an area in which freedom is absolutely critical to health, liberty, and the pursuit of happiness."

(Psychiatric News, September 20, 1996)