CIRCULAR LETTER #663 - PRE-MEETING SPRING 2023

DATES OF FUTURE GAP MEETINGS:

2023

April 20–22

Hyatt Greenwich

Old Greenwich, CT

November 9–11

Sonesta Hotel, White Plains, New York

2024

April 4–6

Sonesta Hotel

White Plains, NY

November 14–16

Sonesta Hotel

White Plains, NY

GAP OFFICERS:

President

Calvin R. Sumner, M.D. docsumner@gmail.com

President Elect

Robert P. Roca, M.D. rroca2@jhmi.edu

Secretary

Sy A. Saeed, M.D. saeeds@ecu.edu

Treasurer

Gail E. Robinson, M.D. gail.robinson@utoronto.ca

Past President

Lawrence S. Gross, M.D. lgross@usc.edu

Message from the President

Greetings, everyone.

I found the Fall retreat to be enlightening and invigorating. The synergy of so many GAP members working together was powerful. I’m looking forward to the Spring GAP meeting with renewed enthusiasm. By popular demand, we’re going to continue the discussions begun at the Fall retreat in our Spring plenary session titled, “Reimaging GAP II: Promise and Deliver.” The plenary for the Spring meeting was to have been the presentation of the Dear Abby award to Congressman Jamie Raskin. Unfortunately, that plenary presentation had to be postponed to allow the Congressman to attend to some health issues. This schedule change gave us the opportunity to continue the important discussions begun in the Fall retreat in the plenary time slot. Please complete your meeting registrations, if you haven’t already, and make plans to join us for the plenary session on Friday afternoon. Join me at the meeting in congratulating our GAP members Ramaswamy Viswanathan, Gabrielle Shapiro and Kenneth Ashley who were successful in their bids for election to leadership positions in the American Psychiatric Association. Vis received the most votes for the top position as the new President-Elect, Gabrielle won the race for Secretary and Kenn will be the incoming Area 2 Trustee. We’re very proud of Vis, Gabrielle and Kenn in continuing the legacy of GAP members serving in leadership roles in American psychiatry.

Significant events from local to global impact mental health and the delivery of mental health care. Part of the mission of GAP is to address those impactful events at the interface of the psychiatry and society with reasoned opinion and recommendation. Several times a year requests are received by GAP to “sign on” to organized petitions expressing opinions shared by multiple organizations and/or individuals. GAP has been consistent in response to these requests by politely declining to sign on to any document authored outside of the organization. GAP has a long history of effectively addressing issues of public concern through the products of its committees and not through organizational endorsement of public positions or statements. While GAP committees can and often do take strong scientifically substantiated positions on issues of public controversy, the organization does not.

Every GAP member has the right to sign on, as an individual, to a public petition. In signing a petition, a member may list their organizational affiliations, including GAP, but must note that the view expressed is their own and not the affiliated organization(s). A GAP committee could choose to submit to the petitioned jurisdiction a learned opinion regarding the issues (like an amicus brief), providing professional opinion and insight. In essence this would be a GAP publication and should go through the Publications Board. GAP Committees may choose to disseminate learned opinion on the issues in a publication (print or electronic). Several

Message from the President

Continued.

committees jointly might produce a position paper or statement on the issues that could be vetted through the Publications Board and disseminated through our diverse publication outlets. The GAP Blog is recent and timely innovation in the publication avenues available to Committees and approved the Publications Board process. At the Spring meeting, we will be welcoming 14 new GAP Fellows who are starting their two-year fellowship experience in GAP. I’ve read through their fellowship applications, and I can say without qualification that this is a stellar group of young psychiatrists. Part of the richness of the GAP fellowship is the opportunity to interact on a personal level with a diverse group of

ANNOUNCEMENTS:

a. The Nominating Committee announces four nominees for the election to the Board of Directors of two members at the April Meeting:

psychiatric leaders like the GAP membership. Please reach out and get to know all our GAP Fellows. Finally, we’re going to be adding photos to our member registry on the website. I don’t know about you, but it helps me to associate a name with a face. We have arranged for a photographer at the Spring meeting to take headshots of all the attendees. We’re not so naïve to think that we’ll get this accomplished on the first pass, but our goal is to eventually have the names and faces of all members on the roster. All for now. Look forward to seeing all of you in April.

All the best,

Calvin R. Sumner, M.D. President, Group for the Advancement of Psychiatry

JACOB APPEL, M.D.

Jacob M. Appel is currently Associate Professor of Psychiatry and Medical Education at the Icahn School of Medicine at Mount Sinai in New York City, where he is Director of Ethics Education in Psychiatry, Assistant Director of

the Academy for Medicine and the Humanities and Medical Director of the Mental Health Clinic at the East Harlem Health Outreach Program (a student-led free mental health clinic for undocumented immigrants). He is also actively engaged in pro bono asylum evaluation. Jacob first joined GAP as a Ginsburg Fellow in 2011 and is now co-chair of the Committee on Psychiatry & Law and a member of the Publications Board. He also teaches in the bioethics program at Albany Medical College. Prior to joining the faculty at Mount Sinai, Jacob taught most recently at Brown University in Providence, Rhode Island, and at Yeshiva College, where he was the writer-in-residence. In his non-psychiatric life, Jacob is the author of five literary novels, ten short story collections, an essay collection, a cozy mystery, a thriller, a volume of poems and a compendium of dilemmas in medical ethics. He served as a

LUDMILA V. BARBOSA

DE FARIA, M.D.

Dr. Ludmila De Faria is an adult psychiatrist who brings an intersectional perspective (woman, IMG, Latina, training director, educator) to her work in Psychiatry. Her clinical focus

judge for the 2022 National Book Critics Circle Awards.

Ludmila V. Barbosa De Faria, M.D., DFAPA, Associate Professor, Psychiatry, University of Florida

Jacob Appel, M.D.

ANNOUNCEMENTS: Continued

is on College Mental health and transitional age youth, and she has a special interest in and works closely with minority populations, increasing access and decreasing mental health disparities among minorities and providing a culturally sensitive environment for patients and trainees. She is an Associate Professor of Psychiatry, Interim Program Director for the Residency Training, and the Director of Diversity, Equity and Inclusion for the Department of Psychiatry at the University of Florida in Gainesville. Dr. De Faria was born and raised in Brazil, where she received her medical degree from the Universidade de Brasilia, and moved to the United States in 1991 to participate in the competitive William J. Harrington Training Program for Latin America and the Caribbean at Jackson Memorial Hospital/ University of Miami, where she stayed for the next 2 decades, as a researcher, resident, and then faculty. Since she joined the University of Florida, she divides her time seeing patients, teaching, and participating in research. She has developed a Diversity, Equity, and Inclusion curriculum across the four years of residency training and created a Research/ DEI elective rotation to foster research and diversity experience in trainees. She is a distinguished fellow of the American Psychiatric Association and serves as the Chair of the Committee of Women’s Mental Health, and a member of the Psychiatric News Editorial Advisory Board. Dr. De Faria received a Presidential

Commendation in 2022 for her work with the Committee on Women’s Mental Health, where she strives to use her intersectional lenses to connect people and ideas and raise topics that are important for overlooked groups. She is member of the American College of Psychiatrists and the Group for the Advancement of Psychiatry and is part of the Leadership Council for the Florida Psychiatry Society, the Association for Women Psychiatrists, and a founding member of the Association for College Psychiatry.

for the Accreditation Council for Graduate Medical Education (ACGME). She was previously Vice Chair for Education and Director of Residency Training in Psychiatry at NYU. From 20012011, Dr. Bernstein also served as the Associate Dean for Graduate Medical Education and the Designated Institutional Official for ACGME accredited training programs at NYU. Dr. Bernstein is a Past-President of the American Psychiatric Association and served the Association as Vice-President, Treasurer and Trustee-at-Large and as the chair of multiple committees.

Carol A. Bernstein, M.D. is Professor and Vice Chair for Faculty Development and Wellbeing, Departments of Psychiatry and Behavioral Science and Obstetrics and Gynecology and Women’s Health at the Montefiore Medical Center /Albert Einstein College of Medicine. She is also a Senior Scholar in the Department of Education and Organizational Development

Dr. Bernstein completed medical school at the Columbia University College of Physicians and Surgeons. Following an internship in internal medicine at St. Luke’s/ Roosevelt Medical Center in New York, she completed her psychiatric residency training at Columbia University and the New York State Psychiatric Institute. Dr. Bernstein is active in many national psychiatric associations in addition to the APA—these include the American College of Psychiatrists where she is currently the Treasurer of the Board of Regents, the Group for the Advancement of Psychiatry and the American Board of Psychiatry and Neurology, among others. Dr. Bernstein has been a member of GAP since 1997. She chaired the Committee on Medical Education and in 2019 helped create and now co-chairs the GAP Media Committee. From 20102016, Dr. Bernstein served on the Board of Directors of the ACGME

CAROL A. BERNSTEIN, M.D.

Carol A. Bernstein, M.D.

ANNOUNCEMENTS: Continued

where she co-chaired the ACGME Task Force on Physician Well Being. She is also amember of the Action Collaborative on Clinician Wellbeing and Resilience of the National Academy of Medicine and has received numerous awards from national organizations including the APA, the ACGME and the American College of Psychiatrists.

GAP and the founding chair of the Committee on the Arts and Humanities. He has served on the GAP Publications Board and currently serves on the GAP Fellowship Committee. David is a committed GAP member and hasn’t missed a meeting since he was a Fellow on the College Student Committee during from 2009 to 2010. He continued as a Ginsburg Fellow on the History Committee before forming the Arts Committee, which later merged with the History Committee to form the Arts and Humanities Committee.

David Sasso is the Chair of the GAP Committee on Arts & Humanities. He is a child, adolescent, and adult psychiatrist and psychotherapist in Connecticut, where he maintains a private practice in Westport. He serves as Assistant Clinical Professor of Psychiatry in the Department on Psychiatry and in the Child Study Center at Yale University School of Medicine, where he acts as a psychotherapy supervisor for child psychiatry fellows and runs a weekly group supervision for interns on their adolescent inpatient rotations. He is a Senior Fellow of the

David received his MD and MPH from the Feinberg School of Medicine at Northwestern University in Chicago, Illinois. He trained in Adult, Child, and Adolescent Psychiatry at the Yale University School of Medicine, where he was Chief Resident in both the Adult and Child programs. He served for 9 years as Medical Director of the Child Guidance Center of Mid-Fairfield County, where he treated the Spanish-speaking population in Norwalk, CT. He maintains a private practice in psychiatry and psychotherapy in Connecticut. David is passionate about the role of the humanities and humanistic thinking in psychiatry and psychiatric education and about the importance of psychotherapy as a central component of psychiatric training and practice. Prior to medical school, David grew up in Indianapolis, Indiana and studied at the Indiana University Jacobs School of Music,

where he received a Bachelor of Music in Music Composition alongside a B.S. in Biochemistry. His full-length opera featuring children as the main characters and performers, The Trio of Minuet, was premiered in 2003. His published children’s choir works are performed around the country. David has worked with patients at Connecticut’s state psychiatric hospital for youth to create a series of original opera scenes with the plot and music generated by the hospitalized teens themselves. These “Riverview Operas” were performed privately at the hospital and subsequently produced and presented publicly by the Hillhouse Opera Company in New Haven. In recent years, David has focused on various traditional folk genres on mandolin-family instruments. His duo project, Kat Wallace and David Sasso, has released two albums to local, national, and international critical acclaim. He recently appeared as a guest on “Times Will Tell,” a podcast of The Times of Israel, discussing his music and the many intersections between psychiatry and the arts. You can often find David performing or leading a jam session after Friday night dinner at GAP meetings.

b. We are reprinting an article written by Doug Kramer, M.D., Chair of the Research Committee, published by American Academy of Child and Adolescent Psychiatry News, Opinions discussing the value of GAP. See the following pages.

DAVID SASSO, M.D.

David Sasso, M.D.

The Value of GAP: VGAP = Q/C: The Secret of Multigenerational Professional Creativity

■ Douglas A. Kramer, MD, MS

To my knowledge, the Group for the Advancement of Psychiatry (GAP) is the only organization of its kind in psychiatry, medicine, academics, business, or government in terms of its creativity, productivity, collegiality, and contributions to our field, our patients, medicine as a whole, and society. The value of GAP approximates infinity. How does an entity so inexpensive in monetary terms have so much value? Value is defined, at least in the healthcare world, as Quality divided by Cost (V = Q/C). Infinity could be realized either by the numerator (Q = ∞) or the denominator (C = 0). There is some cost to membership in GAP, so the value comes from GAP’s quality approaching infinity.

The factors contributing to the quality function include the structure of GAP, GAP members, and the origins and traditions of GAP. Without the structure put in place by the founders in 1946, GAP would by now have evolved like every other organization with noble beginnings, including those that continue to function well and provide a valuable service, but lose their creativity and the passion of the membership by becoming too large to function interpersonally, too bureaucratic to adapt to a constantly evolving mission, and too overly codified of which codification is often a good faith effort to preserve the original value of an organization. Codification eventually suffocates the human element. The human element being where the value of GAP is continuously recreated across generations, just as occurs every day in the natural world.

To my knowledge, we have never discussed this, but the present GAP

membership of 222 Active and Life Members, and the current staff of 0.8 full-time employees, may be approaching the horizon of the ideal life-producing maximum that sustains the vitality of this organization. What is this wonderful structure that preserves the possibility of such vitality? It is the decentralized, bottom-up, committee-based foundation of GAP (Brafman 2006), in the context of the larger GAP organization whose purpose is to support the mission and efforts of each committee, while at the same time facilitating inter-group interaction and cooperation, and educational, collegial, and social interchanges within the group as a whole. The tangible and intangible contributions of each committee tend to catalyze psychiatric, medical, and societal advancement through the creative processes of each committee outward to the larger world. Aside from maintaining this creative structure, GAP directly supports this vital process through a number of functions, such as the work of the Publications Committee, the Plenary Committee, the Ginsburg and Ittleson Fellowships, and liaison relationships with a number of interested psychiatric publications, as well as by interacting with the donor world, free of commercial erosions to the creative essence of GAP.

The founding members of GAP set the tone for the generations that followed. GAP is not an elite club, but there is a mutual selection process that results in a “think tank” friendly membership. The process is so intellectually stimulating and

physically energizing that members rarely resign, but go out “with their boots on.” World War II had exposed how extensive the mental health problem was in the United States and how inadequate were the services available. An unexpectedly high percentage of draft rejections for psychiatric reasons, huge numbers of wartime psychiatric casualties, deteriorating public mental hospitals, and an almost total absence of community services caught the attention of psychiatrists, especially those who had served in the military, as well as the general public (Deutsch 1959).

GAP was born on May 27, 1946, in Chicago, out of a post-war social reform movement for the mentally ill. Some of the initial leaders are still relatively well known today, including William Menninger, Karl Menninger, Henry Brosin, Roy Grinker, and O. Spurgeon English (English 1946). I had the good fortune of meeting Spurge English at his Philadelphia home in the 1980s where he was still seeing patients at the age of 85; and more importantly, still intellectually alive – the epitome of a GAP member! Membership in GAP is not a stepping-stone to National Institutes of Health grants, academic advancement, chairmanships, or large book contracts. I often joke that the idea of a “psychiatric think tank” is an oxymoron. Part of my point is actually that the process is more fundamental than evoked by the standard think tank. A fellow AACAP Research Committee member coined the idea that the creative process of GAP is

“To my knowledge, the Group for the Advancement of Psychiatry (GAP) is the only organization of its kind in psychiatry, medicine, academics, business, or government in terms of its creativity, productivity, collegiality, and contributions to our field, our patients, medicine as a whole, and society. The value of GAP approximates infinity. How does an entity so inexpensive in monetary terms have so much value? Value is defined, at least in the healthcare world, as Quality divided by Cost (V = Q/C).”

“conversational thought,” which distinguishes what GAP facilitates from the vision of experts writing position papers in the solitude of their private offices.

The ongoing multigenerational creativity of GAP results in what we commonly refer to as “GAP products,” publications reviewed, edited, and approved by the GAP Publications Committee, which appear in a wide range of media, including media available to the general public, thus continuing the tradition of informing and influencing at a societal level. There are also intangible GAP products, outcomes of GAP participation that we observe but cannot measure, i.e., better patient care, teaching, supervision, leadership, and the publication of non-GAP

articles, all catalyzed and influenced by the GAP version of a think tank. The GAP version of a think tank is more in line with what former Ittleson Fellow, Walter J.Freeman, M.D., one of the leading neuroscientists of the 1980s, 1990s, and 2000s, once wrote (Freeman 1995): “The most important function of brains . . . is to interact with each other to form families and societies.” GAP is a society of brains interacting for the benefit of our patients, our field, and society as a whole. The Value (V) of GAP approaches infinity because the Quality (Q) of GAP does. m

References

Brafman O (2006). The starfish and the spider: the unstoppable power of leaderless organizations. New York: Portfolio

Deutsch A (1959). The story of GAP. New York

English OS (1946). Psychiatry’s contribution to peace. Philadelphia Medicine. 41:1587-1591

Freeman WJ. Societies of Brains: A Study in the Neuroscience of Love and Hate. Hillsdale, NJ: Lawrence Erlbaum Associates; 1995

Dr. Kramer is emeritus clinical professor, University of Wisconsin School of Medicine and Public Health; AACAP Council counselor-at-large; and chair of the GAP Research Committee. Dr. Kramer may be reached at dakrame1@wisc.edu