Better Mental Health for Older People




President Bergener Takes Charge

Once Manfred Bergener had made a commitment to IPA and had concluded that our goals were more important than personal and professional acceptance by his European peers, he committed himself to the organization with energy, creativity and charisma. The depth of his caring and the power of his energy and commitment became a critical factor in IPA’s growth and success.

IPA’s first workshop was held in Cologne in October 1984. Seventy people attended, mostly local Germans. I was one of a handful of non- Germans. The academic and intellectual components were very strong, and the meeting resulted in the publication of a book.

By now, word had gotten around the professional community that IPA was not going to go out of existence and was putting considerable efforts towards moving the field ahead. The World Psychiatric Association’s section on old age psychiatry attempted to form a new organization within the context of WPA. However, WPA had several handicaps. For one, the WPA is based on national organizations rather than individuals, although individual members of sections were permitted. Second, it is not an interdisciplinary organization and consists solely of psychiatrists of other national organizations. Third, there was no financial structure to support such an organization. Nevertheless, it appeared to many that it would quickly overtake IPA. In fact, in the spring of 1985, a kick-off meeting took place in Baltimore, Maryland. Johns Hopkins Hospital was actively involved and Brice Pitt, the noted English psychogeriatrician, agreed to edit the newsletter. Manfred and I thought that it was important to attend this meeting and to support this new organization, even if it would compete with IPA. Accordingly, he flew into Chicago, and we went to Baltimore together. The trip was a memorable one for a variety of reasons. The turbulence was worse than either Manfred or I had ever experienced. I did not know then what it augured for the next day!

The meeting was scientifically excellent and a good time was had by all. It seemed that there may have been some discomfort about Manfred’s and my presence, but we had determined that we would support the field in any way possible.

This meeting left us convinced that the field was ready to move ahead. As a result of increasing funding from the National Institute on Aging and National Institute on Mental Health, more research was occurring. Clearly, there was a reason to have more frequent meetings, as our knowledge base increased along with the need for dissemination.

We decided that we would increase the publication of the IPA newsletter to four times a year. Charter Barclay Hospital continued to provide postage, but we had to begin to charge dues. We established $35 as an appropriate dues figure, and several hundred people joined in a short period of time.

In the summer of 1985, things were clearly starting to turn around. In July 1985 there was an International Association for Gerontology meeting in New York City. Manfred and I both came in. We had a meeting with Gosta Bucht who indicated that the preparations for the Second Congress of the IPA in Umeâ, Sweden in August 1985 were going extremely well. We had been concerned that the Congress, one month after the IAG Congress, would not be well attended. However, it appeared that we would exceed our original estimate of 200 to 300 people. It was at this meeting that I first met Kazuo Hasegawa, who enthusiastically joined the IPA Board of Directors. We also determined that Manfred’s term as president would end in 1987. Gosta Bucht, who was working so hard in promoting the Second Congress, would follow him. Further, Kazuo, the most noted geriatric psychiatrist and clinical researcher in psychogeriatrics in Asia, would become President-Elect. In addition, Kazuo indicated that he would organize the Fourth Congress of IPA in Tokyo, in September 1989.

The meeting in Umeâ was outstanding in every way. The scientific program was the best I had ever experienced. Six hundred people attended. It was there that I began the tradition of singing at Congresses. They had a swing band, and I fit right in. I was on such a high that afterwards I played piano for two hours, making myself good and hoarse.

Elliot Stein became a member of the Board of Directors from the USA. Carl Eisdorfer attended the meeting out of curiosity and was very impressed. It was in Umeâ that Elliot and Carl agreed to move forward with the American Psychiatric Association and the American Board of Psychiatry and Neurology, promoting added qualifications in geriatric psychiatry. Elliot had been a long promoter of this, as was Gene Cohen. However, Carl had been opposed until then. Seeing the level of scientific programming and the clinical and research participants in Umeâ, he became convinced that the field had arrived. The next week Carl joined IPA.

The success of the Congress got around quickly. Sir Martin Roth agreed to join the Board of Directors. Raymond Levy became a member. Both had been holding out, but now saw the importance of moving ahead. The Board of Directors had a wonderful time at Bengt Winblad’s house, eating sour herring. Raymond Levy sang in Arabic, much to the delight of Abdul Ashour. We sang and laughed and joked around. Clearly, this warmth and collegiality—a vague dream in 1984—was established by 1985. The Swedes deserve a lot of credit for their high scientific standards, hard work and ability to have and share a great time.

Shortly thereafter, Brice Pitt put out the second newsletter of the WPA geriatric psychiatry section. He reported that this would be the last newsletter of this organization. He felt that IPA was accomplishing everything that WPA had desired. Thus, there was no reason to continue. He urged all to join IPA and to support our efforts in building an international organization. The dispute with the British had ended earlier, with Tom Arie accepting an invitation to speak in Umeâ. Unfortunately, a change of meeting dates conflicted with a family commitment and he was unable to come. Manfred could return to respectability, and he was once again welcome in professional psychogeriatric circles in Europe.

This turnaround energized him further. He was coming to Chicago on at least an annual basis, leaving us much time to talk about the future of the organization. We had many dreams and plans and for the first time it seemed like there was no limit to how IPA could grow. We felt strongly that the “nation of older people” worldwide would continue to expand and with it the need to understand the psychopathology of late life as well as the components of successful aging.

In September of 1986, Michel Delcros organized the second workshop of IPA in Paris. We held this in conjunction with the Alzheimer’s Disease and Related Disorders Association (now the Alzheimer’s Association) and Michele Allard at IPSEN sponsored a boat ride on the Seine for both organizations. It was here that Ashour and Tropper and their wives had a wonderful evening together. There for the first time I realized a phenomenon which later Ed Chiu would call “join IPA and see the world”. As we passed the Eiffel Tower at night, it was breathtaking. The whole experience in Paris professionally and personally couldn’t have been better. Many geriatric psychiatrists from the USA who were fluent in French presented —Jerry Yesavage, Gary Gottlieb, and others.

I still had the problem and challenge of the Third Congress of the IPA. When I returned from Basel in early 1984, I went about looking for the hotel that would be willing to provide accommodation and conference rooms for the Congress. Because the organization had such a limited track record, virtually all the hotels in Chicago turned me down. This was especially easy to do because the organization had no positive balance sheet, and we could not guarantee a number for attendance. In 1984, I had planned to have three- to four-hundred people. Only two hotels were willing to “take a chance.” The beautiful, century old, Palmer House was an ideal setting – very attractive to Europeans (as well as Americans), recently renovated, and willing to take a chance on the last week of August, traditionally the slowest time of year. As we got to 1985, I badly needed funding to begin some preliminary announcements. Fortunately, Harry Beaty, Dean of Northwestern University’s Medical School, agreed (at the urging of Hal Visotsky, Chair of the Department of Psychiatry) to come up with $10,000 seed money. We had already decided in Umea that if the University was willing to take the risk, that they would share 50 percent of profits. We made the same agreement with Northwestern. Nevertheless, the Dean was prepared to sacrifice the funds in order to be involved in what looked to be a landmark meeting.

When we drew 600 participants in northern Sweden, I sensed that we could draw as many as 900 in Chicago. Further, the $25,000 profit from Umeâ allowed us another $12,500 for printing and distribution. Industry sponsorship was virtually non-existent. Fortunately, however, Sandoz did sponsor one plenary session. The late Bill Connelly was extremely helpful in this regard. He continued to be a friend to the organization even after his retirement.

Even with the influx of money, I had to sign my name to several agreements. If the meeting were a bust, I was at risk for up to $200,000—a staggering amount. I was highly motivated to see the meeting succeed! And, succeed it did in every way. The scientific program was incredible with a mix of prominent speakers, including Cardinal Cody, Philip Klutznik (the Secretary of Commerce under President Jimmy Carter), award-winning basic scientists from around the world and a huge interdisciplinary program. Even more importantly, the interfacing and crossfertilization that took place created a basis for rapid growth in the field and catalyzed many research, clinical and educational activities. Socially, we were at the Art Institute one night, the Museum of Science and Industry another and the Rehabilitation Institute of Chicago yet another. All the programs were successful and the warmth and collegiality exceeded my highest expectations.

All of us were on a high by the meeting’s end. The Board of Directors meeting was full of energy and creative ideas. I felt like someone who had just won the lottery. How could IPA go from a “renegade organization” to the organization of our field within such a short period of time?

The Swedes had taken on a major leadership role, partly spurred by the success of Umeâ. This provided geriatricians, as well as psychiatrists and a whole range of interdisciplinary staff.

By meeting’s end, Manfred had arranged for the publication of a two volume book on clinical and scientific psychogeriatrics, which contained chapters from international experts who spoke at the meeting. Further, he and I sat down with Ursula Springer of Springer Publishing Company to outline a journal. The International Journal of Geriatric Psychiatry had begun publishing shortly before, and their editors expressed great concern about yet another journal in the field. However, it was clear even then that the amount of research in our area was increasing so rapidly that there would be need for many journals. We signed a contract for International Psychogeriatrics shortly thereafter. As editor, Manfred suggested Gene Cohen, former founding director of the NIMH Center for the Mental Health of the Aging and soon to be Deputy Director of the National Institute on Aging. Gene was a perfect choice. He brought in important American researchers, and Manfred brought in key papers from Europe and Asia. Kazuo Hasegawa and Manfred were Associate Editors and in the beginning, I was Managing Editor, though moved up to Associate Editor within a couple of years.

By 1987, we were meeting twice a year. Helmuth Lechner, neurologist, sponsored a meeting in Baden-bei-wein in early 1987. Though this was a small meeting, Femi Agbayewa, a Nigerian-Canadian, attended. This began his tenure with IPA, which resulted with his coming on the Board of Directors and led to the planning of the 1999 Vancouver Congress. In the meantime, Bengt Winblad moved to Stockholm to take on a major program. Gosta Bucht then became Director of Geriatric Medicine in Umea. Thus, our two principles in Umeâ were promoted within a couple of years. This was a pattern that would occur for many years thereafter, with other IPA Congress organizers.

In April of 1988, Jean Wertheimer, WPA geriatric section treasurer, held a joint meeting of IPA and the WPA section on old age in Lausanne, Switzerland, with Tom Arie enthusiastically present. Jean was a member of the Board of Directors of IPA and later chair of the WPA geriatric section. He was one of very few who were able to bridge both gaps in the very early days. Highly respected by all for his work in service delivery in psychogeriatrics, he was a perfect person to bring both groups together. Clearly, any hard feelings appeared over, and, indeed, to the best of my knowledge never came up again. In 1999 in Vancouver, shortly before his untimely death, Jean was a recipient of an IPA lifetime achievement in psychogeriatrics award, an honor also conveyed on Tom Arie and Kazuo Hasegawa.

A prominent professor of gerontology/geriatrics, Dr. Edit Beregi, sponsored our second meeting in 1988. Held in Budapest, it marked our first meeting behind what was still known as the Iron Curtain. Again, the meeting was scientifically excellent, and we all loved Budapest.

With each meeting, IPA established greater credibility. In 1988 Tom Arie became a member of IPA. Ten years later he would write a chapter about the history of psychogeriatrics in which he would speak admirably about the organization!

Manfred continued to be on a roll. He was able to make contact with people high up at Bayer Pharmaceuticals, and Bayer agreed to sponsor the IPA research awards. These were first given at our 1989 Tokyo Congress. The first three winners were emerging researchers—Barry Rovner of the United States, Henry Brodaty of Australia, and Alistair Burns of the United Kingdom. In the ensuing decade all three became extremely well known and productive clinical researchers. Further, Henry and Alistair joined the Board of Directors and Henry also organized the scientific committee of the Seventh IPA Congress in Sydney, Australia. Ed Chiu was the Congress Chair.

We were excited about the 1989 meeting in Tokyo. The Japanese, led by Kazuo Hasegawa and Akira Homma, presented a stupendous scientific and social program. No one who attended will ever forget that meeting. One of the keynote speakers was Tom Arie. By then, Kazuo was also becoming President of IPA and I was elected as the following president. The Board awarded the 1991 Congress to Jerusalem, Israel, under the leadership of Meinhardt Tropper. Further, it awarded the 1993 Congress to Germany under the leadership of Manfred Bergener. Originally, the meeting was planned for the small historic town of Bamberg. Subsequently, with the fall of the Berlin wall, the BOD encouraged Manfred to change the site to Berlin, which he did.

We still had problems. For one, we didn’t have much money. Sponsorship from pharmaceutical companies—the Bayer awards excepted—was sparse. The cost of the journal was high. We could not raise dues beyond a nominal amount (about $75 in those days), which was still a lot for many health care providers in developing and even some developed countries. The organization required loans, and it was only with these personal loans that we were able to attain financial viability.

Another major contributing factor was Fern Finkel. She had left her employment in 1984 and had begun to work as a volunteer on the 1987 Chicago Congress. Because of the financial crunch of the Congress, there were only funds for one hired employee, a secretary. The rest was a family affair, with Fern leading the way, and our kids playing a major role at different times. All five of our children and parents and aunts worked the Chicago Congress. We were also blessed with 90 volunteers, generous in their time contribution. Fern continued to play a mostly volunteer role for many years to come. However, as we began to publish the journal, there was more of a demand for her time. She became the managing editor of the journal, as well as the newsletter, and increasingly put unreimbursed time into building the organization. Her volunteer work would continue for many years before she became a paid employee.

Finances aside, we now were the organization we had set out to become. We had a quarterly newsletter, a semi-annual journal, two meetings a year with every fourth meeting an international congress, and research awards for outstanding new contributions to our field. Further, IPA was impacting the growth of national organizations. New organizations in psychogeriatrics were being spawned—for example in Japan and Finland. The American Association for Geriatric Psychiatry, impressed with IPA’s accomplishments, began its own annual meetings and started to plan for a journal. They brought in Gene Cohen to be their first editor- in-chief. He left International Psychogeriatrics shortly thereafter.

At that time, it appeared to me that the goal of IPA was to consolidate its rapid gains and to make sure the journal, awards and meetings were at the highest level. We did this, yet were soon to forge other new directions. Regrettably, however, we were about to have several setbacks in the form of war, terrorism and natural disasters. Between 1991 and 1996 we had to cancel or change the venue of three meetings because of international events. This impeded the rapidity of growth, but did not stop it. Rather, they made each new milestone more important and more gratifying.

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

History of IPA, Part Two: December 1982—February 1984: Much Pain, Little Gain

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.

Copyright 2014 International Psychogeriatric Association