Response to the Presidential Address: Toward the APA of the Next Century

We are positioned to gain back our future.

Any doubt will be dispelled by a look at our recent victories in action by the federal government, by Congress, by the courts, and by many state legislatures. Most important, we are winning in the court of public opinion.

My remarks today will be short. Today I want to be short in promises; next year I want to be long in accomplishments.

First of all, I want to thank the giants sitting with me today. APA leaders often shine because of the work of their predecessors. APA Presidents know that the road to success is always under construction, and each of us, like Dr. Sacks and I last year, and Dr. Tasman and I next year, does not seek to see through each other, but wants to see each other through.

My friends, I will devote my efforts to the science of psychiatry. The secrets of the brain are in front of us. Powerful technologies in neurochemistry, imaging, and genetic studies are demonstrating what we already knew: the brain is the organ of psychiatry.

With the help of a task force led by Lew Judd, former Director of the National Institute of Mental Health, I intend to bring to every psychiatric office the good news about the new paradigms in the diagnosis and treatment of depression and anxiety disorders, bipolar disorders, schizophrenia, chemical dependence, Alzheimer’s disease, and other psychiatric disorders.

Winds of change are blowing very hard in the APA of 1998. Dale Walker and the APA Task Force on Strategic Planning will give us a final report after several months of detailed work. Don Scherl and the Budget Committee have conducted a functional analysis. The Board of Trustees and APA Medical Director Steve Mirin will implement a zero-based budget. Jeremy Lazarus will report on strategies to streamline the governance process. Al Tasman and Richard Harding will integrate Government Relations and Public Affairs. John Oldham and his task force have prepared a report on quality performance indicators. Our relationships with the National Institute of Mental Health, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, Veterans Affairs, and the Substance Abuse and Mental Health Services Administration are better than ever. We are taking steps to integrate all the state associations into the APA Network. We are well on our way to becoming the best run, best integrated professional organization in America.

Much of my professional career has been directed to the care of the poor, the homeless, and the chronically ill. My close associates in this have been the cultural minorities, the women, the gay and lesbian psychiatrists, and all those other colleagues who believe in the social mission of psychiatry. This demands that we give the best to those who have the least. I will continue our efforts with the support of child and adolescent psychiatrists, geriatric psychiatrists, psychiatrists working in veterans’ facilities, rural and prison psychiatrists, and the many colleagues who protect the tenets of community psychiatry.

I want to pay tribute to the physicians from all over the world who allowed me to advance with them in APA. In Toronto, where we are all international medical graduates, my tribute includes our Canadian colleagues and, by extension, all the psychiatrists on the planet who share our values and our mission.

One day, when the managed care battles conclude, when the confrontations and cannonades stop, both the physicians and the business community will still be alive. Sooner or later, we are going to have a dialogue. If we manage to talk without intermediaries and with mutual respect, we are likely to advance. If not together, at least in the same direction. I will do my best to create the opportunity to talk and to understand each other. The business community will help if it comes to accept that issues of health are between doctors and patients.

These are unusual times. Exceptional problems require extraordinary solutions. APA members have voted into office a Board of Trustees that is ready to formulate such solutions. I am here asking the APA officers and trustees, the APA Assembly, and the APA components to join our forward-looking Medical Director and me in a new effort to reinvent our cherished American Psychiatric Association.