Replenishing ASAP's vines: Vintage and nonvintage wines

Adolescent Psychiatry,  1999  by Weintrob, Alex

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As immediate past-president of the American Society for Adolescent Psychiatry (ASAP), I am very grateful to Dr. Esman for the opportunity to inform the readership of The Annals of the directions the Society will be taking over the next several years, into and beyond the millennium. These directions will, I believe, be reflected in the contents of The Annals.

It has been 40 years since the formation in New York City of the first local Society for Adolescent Psychiatry. The basic aims stated at that time were "to provide a forum for the exchange of psychiatric knowledge about the adolescent, to encourage the development of adequate training facilitates for adolescent psychiatry, to stimulate research in the psychopathology and treatment of adolescents, and to foster the development of adequate adolescent services" (Schonfeld, 1971). Over the next decade, more local societies formed and then confederated in 1967 as the American Society for Adolescent Psychiatry, whose aims reflected those of the New York Society. Four years later, Adolescent Psychiatry was first published, its purpose,

to explore adolescence as a process . . . to enter challenging and exciting areas that may have profound effects on our basic concepts.... This volume was designed with a twofold purpose. It can stand on its own as a contribution to adolescent psychiatry. However, we hope that it will be the first volume of a series that will provide a forum for the expression of ideas and problems that plague and excite so many of us working in this enigmatic but fascinating field [Feinstein, Giovacchini, and Miller, 1971].

For many years now, both ASAP (in its annual meetings) and The Annals have fulfilled these stated aims, with a primary focus on psychodynamic thinking and treatment, and have acted as the leading proponents in this regard. For example, major contributors at meetings and in The Annals have included, to name only a very few, Anthony, Bettelheim, Blos, Ekstein, Esman, Giovacchini, Kernberg, Marohn, Masterson, Miller, Offer, Rakoff, Rinsley, and Winnicott. This psychodynamic orientation appears to be, if anything, even more important now than it was in the past to those psychiatrists currently finishing their training and entering practice. Many of us have heard complaints from these people that their training was sorely lacking in psychodynamic approaches and instead favored those short-term strategies welcomed by managed care companies. Psychiatrists new to the field have eagerly sought out presentations and articles devoted to psychodynamic thinking. Thus, ASAP is dedicated to preserving and perpetuating such thinking through our annual meetings, our Newsletter, our Journal of Youth and Adolescence (while currently largely a research journal, it is also dedicated to publishing clinical articles), and The Annals (whose editor is a major figure in psychodynamic psychiatry). Thus, the title of this Foreword, which reflects a commitment to preserving our ability to produce the highest quality vintage wines, the seminal thinking in psychodynamic adolescent psychiatry.

At the same time, it is clear that the Society must expand its horizons and play a more active role in speaking out on those issues of great concern to adolescents, their parents, and their therapists. Included among these issues (which were addressed at our last annual meeting by the presidents of all the major psychiatric associations-ASAP, the American Psychiatric Association, the Academy of Child and Adolescent Psychiatry, and the American Association of Community Psychiatrists) are:

1 ) Juvenile justice (in my opinion, an oxymoron in the current public and legislative views). It is becoming increasingly clear that adolescents, and particularly disturbed adolescents, are being very poorly served in the juvenile justice system. (Even this statement may be too generous. There are numerous indications that not only are mentally ill or retarded adolescents who have not committed crimes failing to receive adequate services, but also they are being subjected to punitive treatments in an atmosphere in which they are housed with those who have committed crimes.) Examples of The Annals' response to the overall issue are represented by the publication in Volume 22 of Kalogerakis's (1998) address on adolescent violence at the 1997 scientific meeting and of Miller's (1998) chapter on improving psychiatric services to juvenile justice systems.

2) Psychopharmacologic treatment of adolescent disorders. It is ASAP's expectation that this issue will increasingly be addressed in our Newsletter, at our annual meetings, and in The Annals, perhaps with a subsection devoted to updated information regarding psychotropic medications. I believe it important to note that The Annals represents a marvelous venue for obtaining up-to-date information, as the time from submission to publication is shorter than it is for many scientific journals.

3) Substance use and abuse, especially nicotine, alcohol, and marijuana. This volume of The Annals offers a major article by Jaffe on this subject. It is clear that ASAP's members increasingly are dealing with teenagers and young adults (especially college youth) whose behaviors are adversely affected by these drugs. Recent attention has been drawn to deaths as a result of binge drinking in high schools and colleges. Our members, then, must develop the skills to address this issue both as contributors to public policy and as therapists to these young people and their families.