It's probably much simpler than it's being made out to be. The founder of PSA (later PSAI), Hal Watts, was a bit of a name in the deep air diving world and so there is a course in his agency that is developed to highlight some of the things that he found useful in pursuing those endeavors. The narcosis management course is more like a hallmark that sets PSAI apart from other agencies (as most of the alphabet soup out there are teaching largely compatible things). It's just a unique course offering. I know a few PSAI instructors and most do not teach the course, but will talk about it. It's up to the instructor to teach it, and it's up to the student to take it. If you're not interested in either, I don't believe there's any forcing factor to require it to be either taught or taken.