The Globalization of Psychiatry By Herbert S. Sacks, M.D. APA President

APA commitment to international psychiatry reaffirms that our Association is the largest, oldest, and most powerful professional group in the world advancing education, research, and high-quality care. Noblesse oblige? Certainly not. Colleagues abroad in many nations have made substantive contributions to our field that have benefited suffering patients in our own nation. The character of mental illness respects no borders, respects no systems of government, respects no ideologies.

American psychiatry has put forth positions that have not been well received initially but have most often prevailed at home. Many of these ideas have resonated well with colleagues abroad. Underlying these ideas is an abiding respect for human dignity, with the goal of enhancing personal independence and autonomy. These ideas minimally include the following:

• The destigmatization of mental illness for patients and our medical colleagues.



• The preservation of rights of minorities to psychiatric care to ensure that no one is discriminated against on the basis of race, religion, gender, or sexual orientation.



• The safeguarding of the confidentiality of the doctor-patient relationship and the security of medical records.



• The posting of a patients’ Bill of Rights in hospital wards that informs patients of their right to treatment and their right to refuse treatment.



• The concept of informed consent with the creation of a doctor-patient partnership, enabling patients to participate in their own treatment.



• The medical responsibility for the rehabilitation of substance abusers without turning their sad fates over to the police.



• The advocacy of universal coverage for patient care.

Government systems and the cultural heritage of many nations won’t admit to some of these prerequisites, which we highly value. Our relationships with international colleagues must take into account an American tendency to uphold our own virtues as models for other nations. We have a proclivity to moralize about our beliefs.

Our leadership has been respected in international and regional meetings. Most importantly, APA’s annual meeting has encouraged friendships and advanced mutual undertakings while espousing science. Thousands of international colleagues attend and contribute to the proceedings through presentations and lively discussions, which enrich our own knowledge base.

An important vehicle in our international relationships has been the World Psychiatric Association (WPA), whose newly elected secretary-general, Juan Mezzich, M.D., is a distinguished American. Currently the Council on International Affairs is reviewing APA’s participation in the WPA from the standpoint of organization and structure, mission, cost of national organizations’ membership, relevance of its scientific meetings to our own educational activities, human rights initiatives, and overall effectiveness.

In the past, APA’s engagement with the WPA played a salient role in reversing the Soviet Union’s psychiatric imprisonment of dissidents, including psychiatrists, and the debasement of internationally recognized scientific principles in the service of political ends. Further, in South Africa, APA and the WPA were strong voices encouraging courageous psychiatrist resistance to apartheid. In other parts of the world, as in Northern Ireland and the fragmented nation that was once Yugoslavia, psychiatry has been less successful when registering protest against unspeakable cruelties and violations of human dignity, which have yielded major and pervasive symptomatology in the affected populations.

Tragically, the principal author of the strategy of cruelty in Bosnia-Serbia is psychiatrist Radovan Karadzic. Four years ago the APA Board of Trustees issued a powerful statement decrying his deeds, a statement valid today.

In the recent past, APA has cosponsored with national psychiatric organizations joint scientific meetings in France and Italy, fostering collegiality and scientific exchanges. The pragmatic translation of theory into practice in these nations has given us insight into fresh treatment approaches, in the context of a paucity of resources. In Eastern Europe an APA team-teaching effort organized by Gene Feigelson and former APA president Larry Hartmann was well received. Recently, APA has cosponsored a South African initiative led by former APA president Mary Jane England.

Without APA sponsorship, individual members, like Miguel Leibovich in Boston, have undertaken impressive educational programs in Latin America. Larry Hartmann and other APA members served as visiting professors in Saudi Arabia, and the head of the U.S. Holocaust Memorial Museum, Human Rights Committee Chair Walter Reich, vigilantly represents American psychiatry’s values on the world scene. West and Central African long-term psychosocial projects piggybacked on large international development programs have proven to be invaluable to host nations. And I am proud to have been the architect of that effort. Many of these undertakings would have foundered but for the superb staff work of Ellen Mercer and the enthusiastic support of former medical director Mel Sabshin.

Our preoccupation with the depredations of managed care on quality patient care has turned us inward. Embattled as we are, international undertakings may seem to be beyond our resources, beyond our mission, beyond our members’ interests. As in the larger body politic in the United States, isolationism shrinks our perspectives, denies intrinsic medical values, stunts scientific growth, and compromises America’s international responsibility and burden as the world’s most powerful nation.

Resolution Concerning the Role of Psychiatrist Radovan Karadzic in Human Rights Abuses in the Former Yugoslavia