Response to the Presidential Address

Dr. Lieberman, Dr. Levin, members of the Board, members of the Assembly, state association and district branch leadership, members of the APA, and our many guests. Dr. Schatzberg, thank you for that very kind introduction.

I am profoundly honored to stand here today as I prepare to become the President of this great organization at the close of this meeting. It is especially meaningful to do so in the city of my birth, with the good wishes of my son in Madrid and the presence of my daughter, my wife, and especially my parents. The absence of my brother, of blessed memory, is made far more acute at moments like these.

Before I speak about the APA and this very special moment in the long history of psychiatry, I would be remiss if I did not reflect on the excellent and impassioned job that Jeffrey Lieberman has done as President of the APA and to thank him for his tireless efforts. It took me a while to get a sense of Jeffrey’s style, and it helped to learn that he had been a nationally-ranked quarterback and defensive football player in college. Jeffrey knows how to move the ball downfield, and he is comfortable calling audibles at the line of scrimmage. Very little got past Jeffrey when he played safety at Miami University of Ohio, and I assure you almost nothing has gotten past him as APA President. Jeffrey came to play and play hard every day—to win. He has always, and I mean always, been focused on advancing psychiatry, making sure that we could and did respond to the public and scientific challenges ahead of us. He has been and will continue to be a deeply consequential leader for American psychiatry. I am grateful for his mentorship, example, and support.

We are in a unique period in the history of psychiatry. The recognition and understanding that psychiatric illnesses are the most common disabling and preeminent disorders of young people is now widespread. We are on the cusp of what has been a complex and difficult journey to discover the fundamental mechanisms, underlying genetics, neurobiological substrates, and environmental factors in what have been among the most feared disorders of humankind. This endeavor will not be easy and is testimony to the complexity of the human brain and the unique personal stamp and intimacy of psychiatric disorders. No conditions are closer to our sense of self, and no matter the discoveries about the etiology of these illnesses, their care will always require a respectful attention to the experiences of our patients.

As we recognize the frequency of these disorders, we also recognize their burden—in human suffering, in wasted lives, in the ravages of the wildfires that race across developing brains, leaving young people stunted and besieged. There is also the cost, both psychological and financial, in years of life lost to disability from both mental and medical illness and in lives languishing in the throes of the judicial and criminal justice systems instead of a compassionate and caring medical system. Linked to all of these are stigma, prejudice, and discrimination. Abraham Lincoln, who suffered deeply from depression (or melancholy as it was called in the 19th century), wrote in 1841, “A tendency to melancholy is a misfortune not a fault.” Could any of us say this better?

The impact of mental disorders is also not random. Their roots in both neurodevelopment and early-life trauma make them profoundly disruptive over the long course of many lives. This impact is not just regional or national but global as well—and not just personal but social and communal in profound ways. These illnesses penetrate everywhere and so does the shame and stigma that so sadly travels in their wake. Failing to search for the causes of these illnesses with the hope of treating them effectively and humanely is simply, finally unacceptable.

As psychiatry stands at a cusp, so does the APA. We are the oldest medical specialty organization in the United States and the only one that fully bridges the worlds of general medicine and psychiatry. We must lead, not just because it is right for our field, but because it is right for the patients and families we serve. For 170 years, we have been in a position of trust as fiduciaries for our science and profession. We must continue to live up to that trust.

We now have a once-in-a-generation opportunity. We can set a course for our field to allow us to be effective for the next 20 years, or we can miss the possibilities embedded in this moment.

What makes this moment so special? Mental health today is both in the spotlight and under a microscope. Public interest in mental health issues has never been more intense, triggered in part by events, which make for tragic headlines and leave us all sick at heart. But despite the polarization in Washington, mental illness is not a partisan affair—as we know all too well, mental disorders have no respect for position, wealth, fame, or political persuasion. The children of Democrats and Republicans, of the rich and poor, can, and do, fall ill.

But there is a younger generation that has lived with mental illness, who will not stay silent, who will not hide but will speak out, even sometimes in ways that might discomfort us. They know, as did the early and vocal advocates for gay rights and treatment for AIDS, that “silence equals death.”

The very real scientific opportunities before us are unprecedented in human history. We have never before had the capacity to image the brain, to see the impact of genetic abnormalities on neurodevelopment, or begin to understand the complex ways our brains shape our perceptions of the world and in turn are shaped by them. We also live in a world where health care reform is finally being realized and providing opportunities to fully integrate the care of so many of our patients. Who among us would have a child or brother or spouse with mental illness only to watch them die years too soon from a treatable medical condition? These developments are truly once in a lifetime moments that we dare not waste.

So what are the tasks that lie before us?

First, we need to speak on behalf of both our patients and the growing body of science as physician experts on mental health. This means helping others understand what we know so well as physicians—that these illnesses are real, disabling, and strongly associated with medical comorbidity but also amenable to care, treatment, and the power of contemporary science. To that end, we have a special responsibility to put aside internecine battles, especially those driven by ideology, and go where the science takes us.

Second, we need to advocate for our patients and our profession. Our patients live with stigma, and we do as well. We cannot act in their best interest if we do not speak fully in support of equity and parity. Across this country, every day, psychiatrists take excellent care of patients in hospitals, offices, and yes under bridges and in prisons. Thousands of our colleagues work tirelessly in military and veterans facilities caring for servicemen and women, and we must lend our energy and support to these critical endeavors as well. With regard to our research and academic mission, it goes without saying that this future is dependent on our creativity and imagination, and we must continue our vigorous support for them.

Third, as we talk about mental health, we need to find simple and direct language to communicate with ourselves, our patients, and the American public. We should take advantage of the increased public interest in mental health and partner with allies in the media to amplify our message.

Fourth, we need to embrace our role as global leaders in psychiatry in a manner which not only reflects the strength of our intellectual and human capital but is also deeply respectful of the diversity of our own membership and other cultures. Many parts of our world are undergoing enormous social, economic, and political development and discovering both the importance of mental health in their own countries in addition to the burden that the stigma of mental illness places on their populations. Colleagues from around the world who are experiencing these cultural upheavals have much to teach us as well.

As we set our course to achieve these goals, we must remember that none of these are the work of one President or one Board or one moment in time. These are the ongoing tasks that must animate this great organization and profession for years to come. None of this will come quickly. Indeed, we have already been on a long journey for knowledge and justice. In his quest for civil rights, the words of Martin Luther King ring just as true about our work today and in the future: “The arc of the moral universe is long, but it bends toward justice.”

Our patients, their families, and our profession need our counsel, guidance, and selfless efforts so that when we look back we can all be proud of our work and accomplishments. I am honored to take on this responsibility, to serve and to work for the benefit of our patients, our profession, and our communities.