Response to the Presidential Address

Good afternoon. This is a surreal moment. How could someone who was born in a remote village 12,000 miles away and who did not know English until he entered middle school become the President of the American Psychiatric Association?

This is a great country, and this is a great organization. I want to thank you all for your trust and faith in my ability to lead this largest psychiatric organization in the world. I promise you I will do my very best to justify your trust.

I want to begin by thanking several specific individuals. Henry Nasrallah has been my best friend and respected colleague for many years. He is an incredibly talented and gifted individual.

Bob Michels has been a brilliant and inspiring teacher for numerous people, including myself ever since I did my residency at Cornell. I'm grateful to John Oldham for his mentorship during the past year when I was President-Elect. As the APA President, he has been a role model to me. His ability to get along with people, composure under pressure, perseverance, and thoughtfulness have been exemplary. It will be hard to fill in his shoes. I am delighted, however, that I will be working with Jeff Lieberman as President-Elect. Jeff also has been a close friend and wonderful colleague for many years.

Very importantly, I want to acknowledge my wonderful family and great friends. My wife, Sonali, my life partner, is truly a superwoman. An accomplished child psychiatrist, she also is an incredible mother and the world's best chef for Indian cuisine. I also want to mention several members of my family who are here: Vijay, Shaila, Shrikant, and friends, Vikram, Maya, Ashish and their spouses.

I am proud to be a psychiatrist. I fell in love with psychiatry when I was a teenager in India. I happened to read Freud's books for lay people: Interpretation of Dreams and Everyday Errors of Life. I thought they were more exciting than Agatha Christie's murder mysteries. Instead of solving a murder, Freud sought to unravel the mysteries of the human mind through common behaviors such as dreams and everyday errors.

While I was in psychiatric training in India, everyone there considered the APA as a celestial body. We eagerly looked forward to seeing a copy of the most recent issue of The American Journal of Psychiatry. Becoming an APA member seemed like a dream.

I feel lucky to be a psychiatrist. We psychiatrists take care of one of the most disenfranchised groups in the society. We also try to understand and enhance the most complex organ in the body, the brain. Woody Allen called the brain the second most important organ in the body. He didn't say what was the number one organ for him. Psychiatrists are not at the top of the list of medical specialties in terms of income; however, a recent survey found that psychiatry was in the top two medical specialties in terms of professional satisfaction. This work-related satisfaction was associated not with income but with the amount of time psychiatrists spent with their patients. It should follow naturally that the number one priority for the APA must be to help our patients.

Our primary task is to fight mental illness and to ensure that our patients get the best possible health care. The coming year is going to be a challenging year. The fate of the health care reform is unclear. The Supreme Court has upheld most of the Affordable Care Act. The results of the November election will impact the future of health care reform. We will not have much control over what happens to the overall economy and its effects on health care. However, our job at the APA is to ensure that mental health care receives the priority it deserves and that our patients get the finest available care.

We cannot do this by ourselves, of course. We will have to work with other organizations, including medical organization like AMA, advocacy groups like NAMI, and also other mental health organizations.

We must stay united. There is an African saying, “If you want to go fast, go alone, but if you want to go far, go together.” We need to go together. My focus next year will be on unity. We are one APA. We are one whether we are clinicians or academicians. We are one whether we are early-career psychiatrists or lifers. We are one whether we are in the Assembly or the Board or the district branches.

The APA already is a big tent, but I would like to expand it even further by getting more international members, subspecialists, younger psychiatrists, and those from diverse backgrounds. One of my areas of focus will be international membership. The APA is truly a global psychiatric organization. I would like to increase our efforts in promoting international membership of the APA. The APA also can contribute significantly to educational activities in various other countries, especially the developing countries where there is a serious shortage of psychiatrists.Of course, education is a two-way street. Just as the APA helps with training in other countries, we also learn from those countries.

Another group of interest pertains to psychiatric subspecialties: child, geriatric, forensic, psychosomatic, addiction. The APA needs members belonging to those subspecialty organizations, and they need the APA. After all, APA is the single professional organization that represents our field. A large and strong APA can advocate best for all psychiatric patients.

Another important group to focus on is that of members-in-training and early-career psychiatrists. These are the leaders of the future. We need to do everything we can to mentor them and give them leadership opportunities from early stages. Here again, it is two-way traffic. Just as we mentor our younger colleagues, we also learn from them. Younger psychiatrists are much more knowledgeable about social networking and use of technology than some of us seniors are. And they can help us—help the APA—move into the new era of innovations in health care delivery.

Finally, APA already has considerable diversity in its membership, but we need to make concerted efforts to increase diversity at all levels, including the leadership level.

One major event that will occur during the next year will be the publication of DSM-5. The DSM-5 will be published in May 2013 at the APA meeting in San Francisco. I want to stress that, at present, no DSM-5 criteria have been finalized. The most recent draft of this manual was just placed on our website, DSM-5.org, and will be open for public comments for 6 weeks. We welcome any and all comments. We take any criticism of the DSM-5 seriously because we want it to be the best possible manual of psychiatric diagnoses today. Several hundred psychiatrists and nonpsychiatrists from various countries have spent, pro bono, tens of thousands of hours in helping develop DSM-5. There is a rigorous review process with a Scientific Review Committee as well as a Clinical and Public Health Review Committee. The field trial results are currently being analyzed. The APA Board of Trustees will take into account all of these data, as well as the public comments, in deciding about the approval of various DSM-5 categories and criteria. Just like the original DSM and the DSM-II, DSM-III, and DSM-IV contributed to psychiatry in a major way, so will DSM-5.

The future of psychiatry is bright. Psychiatry will come to play a central role in overall health care. Why do I say this?

I believe that psychiatry's mission will expand beyond reducing symptoms in people with mental illness. We will aim higher. The goal will be not just to improve psychopathology but also to help our patients grow, flourish, develop, and be more satisfied with their lives. That is positive psychiatry. Positive because it focuses on enhancing personal well-being through the use of positive psychosocial factors, such as resilience, optimism, wisdom, and social engagement. These positive psychosocial factors have an impact not only on mental health but also on physical health. Numerous studies have shown that resilience, optimism, and social engagement are associated not just with better emotional functioning but also increases in longevity and better physical and cognitive functioning. I believe that psychiatry is the most appropriate of all the medical specialties to promote these positive traits in people with mental illnesses as well as in those with physical illnesses. More than any other medical specialty, psychiatry focuses on interventions aimed at behavior change. Our psychotherapies will, therefore, come to incorporate these positive psychological traits for people with or without mental illness. Preventive psychiatry will not be an oxymoron.

Psychiatry will also change as the population changes. For example, the world population is aging. The number of people over 65 will double in the next 20–25 years. Some people disparagingly dub this a “silver tsunami,” as if it's a disaster waiting to happen. I strongly disagree with this view. I see the demographic shift not as a silver tsunami but as a golden wave, or a golden revolution, if you will. Older people are a major resource and not a drain on the society. Growing numbers of seniors are functioning at a very high level and contributing to the society in a major way. This type of successful aging is no longer a grandma's tale or a feel-good TV show. It is now an evidence-based scientific fact. Some of the most exciting neuroscience research during the past 15–20 years has shown conclusive evidence of neuroplasticity in aging. Studies across species have shown that brain growth and development are not restricted to childhood but continue into old age. Blood vessels, synapses, even neurons can grow in certain parts of the brain, provided there is optimal psychosocial and physical stimulation.

Successful aging is not a fantasy, it's a fact. The pathway to successful aging is not just through calorie restriction and physical activity, it is also through promoting and enhancing resilience, optimism, wisdom, and social engagement through our psychotherapeutic interventions. The theme for my year of presidency is therefore going to be “Pursuing Wellness Across the Lifespan.”

Like psychiatry, the future of APA also is bright. Sure, we will go through some difficult times, but we will come out ahead.

We have succeeded in the past. After decades of hard work and against all odds, we succeeded in getting the mental health care parity law passed a few years ago. It happened because we worked as a united organization and also because we worked with other organizations such as AMA, advocacy groups, and other mental health organizations.

APA has done a remarkable job in many other ways too. The American Journal of Psychiatry is a premier journal in the world. The DSM has made major contributions to our field over the last half-century. The APA Practice Guidelines have set standards of mental health care not just in the U.S. but all over the world. I have no doubt that we will succeed. We have to succeed because failure is not an option.

Let's work together. Working together, we can help the APA fulfill its mission of being the voice and conscience of psychiatry in the world.

Thank you.