Summergrad Advises the ‘Long Game’ in Period of Change, Challenge

Transformative scientific advances, dramatic changes in health care, and stubborn, long-standing, and persistent problems—together these characterize the state of care and treatment for people with mental illness.

So said outgoing APA President Paul Summergrad, M.D., at the Opening Session of APA’s 2015 annual meeting last month in Toronto.

In this challenging environment, Summergrad advised his colleagues to play “the long game,” adhering to the ethics that have always guided physicians. Early in his speech, Summergrad shared an African proverb that set the tone for his remarks: If you want to go fast, go alone; but if you want to go far, go with others.

A fan of this proverb, Summergrad said he favors a “long, far view—if for no other reason than change is hard, complex, and always takes longer than we expect. We tend to look for instant transformation, analysis, and understanding, which are not always forthcoming, reliable, or desirable. This is especially true at times of great upheaval and uncertainty, which we are certainly experiencing in the sciences related to psychiatry, and more broadly in technology and culture.”

Extraordinary scientific advances are occurring at the same time that the Affordable Care Act has provided the most significant expansion of access to mental health care in a generation, he said.

“[W]e are in the midst of a profound transformation of our understanding of neuroscience, genetics, and epigenetics,” Summergrad said. “That we have not yet achieved interventions based on these insights or diagnostic tests is not because we will not achieve them, but because of the complexity of what we are studying. We know that we are also in a period of substantial change in the way health care is organized and financed. Nonetheless, if we remain true to our mission, the ultimate goals of care must be the same as when Francis Weld Peabody, a great physician, spoke from the well of the amphitheater at the Boston City Hospital when he was dying of cancer in 1928. He said, ‘One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is caring for the patient.’ ”

Summergrad continued, “While the pace of discovery may appear at times overwhelming, the immediate effect on clinical practice is slower and less clear. However, a closer look suggests that we are beginning to focus, especially in large-scale genomewide-association studies, on key pathways in neurodevelopment, inflammation, and transmitter systems that may be implicated in a range of common disorders.

“So immersed are we in the moment that we can be easily forgiven if we can’t see clearly how these changes will affect our views of human nature, our understanding of the brain and mental functioning, and our definition of mental illness,” he said.

At the same time, Summergrad reminded his audience of the “great challenges that stubbornly, seemingly unmovingly, remain with us”—longer emergency department wait times, fewer beds, more patients in prison than in hospitals. “Indeed, some argue we are back to the era when Dorothea Dix investigated the condition of men and women confined to prisons, jails, and almshouses,” he said.

He added that psychiatry faces scrutiny, and sometimes criticism, precisely because psychiatric illnesses involve those capacities that are distinctly human. “The issues of what is considered normal behavior and when illness impairs responsibility are weighty and foundational issues for cultures in general as well as for psychiatry and the law,” he said. “As such, the attention and concern of those who criticize us in its own way clearly reveal the importance of the work we do. It makes it even more important that we do it well, with deep fidelity to science and the essential principles and ethics of medical practice.”

He closed his address with words of encouragement to the medical students, residents, and early career psychiatrists at the meeting. “[A]mong you are future great clinicians, department chairs, policy leaders, directors of research institutes, future presidents of the American Psychiatric Association, and, yes, perhaps one or two Nobel laureates,” he said. “Stay focused on your passion, on what you care deeply about, take great care of your patients, your colleagues, and yourselves. Keep your eyes on the distant horizon.

“See the whole board and play the long game. … Take advantage of the advice and counsel of your mentors and colleagues. You can do it—people believed in me, and we all believe in you. You have a great opportunity for a lifetime of stewardship, service, and science.”

He concluded: “I’m really, really looking forward to seeing what you will do.”

Summergrad was introduced at the Opening Session by his wife, psychiatrist Randy S. Glassman, M.D. She is the first spouse to introduce a spouse at the Opening Session. ■