Spotlight

HISTORY OF IPA, PART TWO
DECEMBER 1982 – FEBRUARY 1984: MUCH PAIN, LITTLE GAIN

SANFORD I. FINKEL

The raucous and intense meeting in Cairo was followed by an almost deafening silence. Shortly after I returned to Chicago, I received a letter from Sir Martin Roth, whom Imre Fejer had “appointed” to the IPA Board of Directors. He indicated that there might have been some misunderstanding and that he would be unable to participate in the organization at this time. As always, Sir Martin was very diplomatic, but clearly he did not want to be tainted with the organization’s reputation. Others also withdrew from IPA.

I also received a call from my good friend Carl Eisdorfer, an acknowledged giant in the field of geriatric psychiatry. He was my most important mentor when I established AAGP, and a source of support and encouragement throughout. Nevertheless, it is rare that I receive a call from him. Thus, when he called and began the conversation with, “Sandy, I love you very much …but what in the hell are you doing?!” I knew what the topic would be. He reiterated that IPA was hurting the field and should not risk my reputation with an outlaw organization. I told him about the Cairo meeting and how I arrived at my decision. He listened with interest, but also with skepticism, and when the conversation ended I felt sick inside.

In 1982, in anticipation of the Cairo meeting, I proposed at the annual Board of Directors meeting of the American Association of Geriatric Psychiatry that AAGP affiliate with IPA. This was approved. However, in 1983, Lissy Jarvik, another outstanding geriatric psychiatrist, had been elected president-elect of AAGP. Jarvik expressed negative views about IPA and wanted AAGP to disaffiliate. However, she reluctantly agreed to defer this issue for a year.

I wrote to Tom Arie when I returned from Cairo, thanking him for the wonderful experience in Nottingham and explaining why I had taken my position. I could not have predicted that within a couple of years he would be supportive of IPA and before the decade’s end he would be keynoting an IPA Congress in Tokyo!

Despite these disappointments, the whole IPA experience had very little impact on me. I was very busy in other activities and was minimally involved with international travel for professional business purposes. The Fejer-appointed Board of Directors agreed to meet on the Sunday night preceding the World Psychiatric Association (WPA) Congress in Vienna, Austria in July 1983. We agreed that we would stay in touch until that time and develop a further agenda in Vienna.

In contrast to my distance from all the emerging politics in psychogeriatrics, Manfred Bergener was affected deeply. He was criticized, vilified and ostracized for accepting the presidency. Both the British and Dutch stopped inviting him to meetings, leaving him cut off from his usual peer group. He had begun studying English and his language skills were definitely improving. So was his understanding of the whole situation. He went from feeling proud to be the founding president in Cairo, to feeling ashamed of the organization and feeling the need to remove himself from any leadership position.

In the meantime, Imre Fejer continued to call Tom Arie at all times of day and night, pleading with him to be more involved with IPA. However, it was planned that the official WPA geriatric section meeting in Vienna in 1983 should try to move the question of an international structure forward, involving the true leaders of our field.

I met with Tom on the Sunday afternoon prior to the inception of the WPA meeting in Vienna. I remember the setting. It was a mammoth conference hall. No one was there but Tom, Dave Jolley from Manchester, one other whom I cannot remember, and me. We sat with the four chairs in the north, east, south, and west directions, dwarfed by the magnificent surroundings. Tom was in favor of winding up IPA and buttressing the WPA geriatric psychiatry section. By then, I already had been in contact with Manfred Bergener, and we agreed that on Sunday night we would vote to eliminate IPA and offer our services to the new organization, should it be in need of them. Therefore, I could tell Tom that IPA would likely vote itself out of existence that very evening with the intent of following him and others under the banner of a new international psychogeriatric organization.

Indeed, that night nine members of IPA met and heatedly debated our future. Manfred argued that IPA was in the way of establishing a viable international organization and should immediately discontinue its activities. I supported him as did Fritz van’t Hooft and Rudolfo Fahrer. On the other side, Imre Fejer and Abdul Ashour strongly argued to the contrary and felt that we had enough to move forward and that under no circumstances should we discontinue the organization. The final vote was 5-4 in favor of termination. However, as a concession to the minority, some of whom had worked very hard to establish IPA, we agreed to meet at the end of the week to reevaluate our decision in the light of the coming week’s activities. I fully expected that by then leaders in the field would be well on their way to developing an infrastructure for a new organization. However, we were not centrally involved in the WPA geriatric section meeting and were concerned that membership of WPA was limited to psychiatrists. Thus, at the end of the week, the board of directors met again. Most were irritated by the fact that we were receiving messages to eliminate ourselves so that the WPA geriatric section could expand, but we did not see much concrete activity. Inasmuch as we all felt that an organization was needed, we voted to reverse our termination and to move forward with the new organization, though with some tentativeness. It was agreed that we would start a newsletter, and that I would be the first editor. Fortunately, when I returned to my work at Charter Barclay Hospital, Charter Medical Corporation – as a reward for the success of the hospital and company in which I was involved and was contributing – the hospital agreed to support the newsletter financially by providing secretarial help, printing materials, mailing and distribution.

The Board agreed to meet again in Basel, Switzerland in February 1984 at the Sandoz Gerontological Awards Meeting, which Manfred chaired. During these few days, the nadir of the organization’s history, I could have no insight into the importance of these awards and to Manfred’s experience in organizing them as a scientific entity. A mere five years later he would utilize his background and experience to establish the now well-known IPA Research Awards.

By the time of the Sandoz Gerontological Awards meeting, Manfred had clearly “had it” with IPA. We had corresponded in the interim. He was pleased that we had begun a semi-annual newsletter and had found financial sponsorship for this. Further, we did have several hundred members, though there was no formal structure for paying dues, and most of the members had been appointed/solicited by Imre.

On the eve of the board of directors meeting, Manfred and I met in the hotel lobby of the Euler hotel in Basel. The future of the organization was at stake. In its short history, IPA had suffered from so many traumas that the resignation of Manfred spelled the end of IPA for all practical purposes. Following his usual enthusiastic greeting, he began discussions with expressions of suffering and agony. The ostracism by the British, Dutch, and others continued. From being “one of the boys”, he had become the equivalent of a leper. When he did speak with colleagues, he was roundly criticized for being involved in this terrible organization. On many occasions, he said, “The other side is not right either. They have not done what they should, and they have been unreasonable. However, we are not respected as an organization and can accomplish nothing. My professional standing is ruined as long as I continue my involvement. It is best for me and for all if I resign as president of the IPA and someone else takes charge.”

By then I had become disgusted by all of the politicking in our field and had developed a determination to move forward if at all possible. I would have immediately accepted another organization in which there was solid leadership and commitment to the field and the people that we serve. I had not seen this at all. Enough was enough! I pleaded with Manfred not to resign and told him that the problem was not that IPA was getting in the way of a meaningful psychogeriatric organization. Rather, IPA was not moving ahead with its mission and objectives, which included fostering education, research and clinical excellence in our field. I believed that no one could criticize us, if that’s what we stood for. We spoke in that tiny lobby for close to two hours. He said that he would think about what we had talked about and would decide by the time of the board of directors meeting the next morning.

It was our smallest board of directors meeting. Only five were there: President Manfred Bergnener, Secretary-Treasurer, Sanford Finkel, Organizer, Imre Fejer, psychiatrist Michel Delcros of Paris and geriatrician Gosta Bucht of Umea, Sweden. I truly believed that this would be the last meeting of the board of directors of IPA and was trying to convince myself that this was a very good learning experience – a wonderful coping mechanism when things are a mess and don’t work out!

As always, Manfred came to the principal point immediately, stating, he had truly believed that it was in his and the organization’s best interest for him to resign as president, and that had been his intention in coming to Basel. Then he discussed our long dialogue of the night before and explained that he had changed his mind. “Our field needs an international organization to support education, research and clinical excellence. We have a growing population of older people throughout the world, and we must now move forward,” he said, noting that it was of critical importance to expand IPA’s activities. The November 1982 meeting in Cairo was a good beginning, but we needed to move on. The knowledge base in psychogeriatrics was about to explode. Biological, psychological and social research was beginning in earnest. Innovative service delivery and educational programs were becoming more common. Several nations were looking at establishing national psychogeriatric organizations. Others, such as the UK and USA, already had them. The field was ready for a higher level of scientific meeting. Accordingly, he announced that later in the year, October 1984, the first IPA workshop would be held in Cologne, Germany, at the Rheinische Landesklinik, where he worked as medical director. To minimize costs, the meeting would be held on site and he would seek approval from the administrator of the hospital immediately upon his return from Basel. Gosta Bucht then replied that there would be a convention center opened in Umea in northern Sweden in July of 1985 and that he would be willing to host the second Congress of IPA in August of 1985. Delcros stated that he would organize the second workshop of IPA in Paris in the early fall of 1986, and I promised to organize IPA’s 3rd Congress in Chicago in summer 1987. The meeting was short and to the point. Manfred was never one to waste much time with idle discussion. I don’t believe that anyone at the table, including Manfred, had any certainty that we would be able to pull all of this off, but we were all committed to trying and doing our best. 

Following the board of directors meeting, the Sandoz awards were presented over a two-day period. There were outstanding presentations by leaders in the field, and I felt a thrill listening to them. Wouldn’t it be wonderful to have meetings of clinicians, researchers and scientists from all over the world on a regular basis? Moreover, many more people could attend than the exclusive group attending the Sandoz Gerontological Awards. On the other hand, it seemed the time was approaching for an international organization committed to the field to establish research awards, and perhaps one of the major pharmaceutical companies could be a partner in sponsoring such an award. In 1984, these thoughts were still pure fantasy.

IPA had lived to face another day, and Manfred, several others and I were willing to work to build a dream. We would have many more difficult years, but by then the worst was really over.

History of IPA, Part One: The Creation of an International Organization—in a Circus-like Atmosphere

Sanford I. Finkel has been a Geriatric Psychiatrist for 33 years. For more than three decades he has participated in the growth and evolution of geriatric mental health, and has shaped part of the field by founding the Chicago Society for Life Psychology and Aging, the American Association for Geriatric Psychiatry, the American Psychiatric Association Council on Aging, and the International Psychogeriatric Association. Dr. Finkel is a clinician who continues to see older people and their family members and is involved in innovative research. Current projects include the integration and utilization of a social worker in improving options for older people with depression and cognitive impairment in primary care medical settings, post-traumatic stress disorder in the elderly, and functional, cognitive and behavioral scale development. He is currently Director of the Leonard Schanfield Research Institute and Geriatric Institute of Council for Jewish Elderly, as well as Professor of Clinical Psychiatry, Neurology, and Internal Medicine at Northwestern University Medical School.