We’ve Come a Long Way

On March 4, I attended my final Board of Trustees meeting of the American Psychiatric Association, the professional organization of which I have been a member for almost four decades. As I sat next to Dr. Altha Stewart, the new (and first African American) president-elect of APA; observed Dr. Maria Oquendo, the current (and first Latina) APA president, lead the proceedings; and listened while Dr. Saul Levin, APA CEO and medical director (an international medical graduate and gay man), presented his report to the Board, I was suffused with feelings of pride and satisfaction at the diversity of APA’s leadership.

In 2012, I had been encouraged by colleagues to run for the APA presidency. This was a departure for me. Although I had participated in many APA roles and activities over the years, I had neither yearned for nor sought a position in the highest echelon of leadership. However, as the chair of a major department of psychiatry and chief of the behavioral health services at our hospital, my frustration with our country’s health policy and financing system had swelled and prompted me to activism.

As I look back on this experience five years later, I feel gratified by what we have been able to accomplish. As president-elect, I had encouraged Maria to run for APA office and was on the search committee that selected Saul to succeed Dr. Jay Scully as CEO and medical director, and then as APA president, officially welcomed and installed him in his position. Dr. Frank Brown, a Native American, was elected treasurer and then, after his term ended, I asked him to stay on the Board as the parliamentarian. When my term in office ended, I chaired, as is the tradition, the Nominating Committee that led to Altha’s election as secretary and Maria’s election as president.

Much has been accomplished in recent years during my tenure and that of my immediate predecessors (Drs. John Oldham and Dilip Jeste) and successors (Drs. Paul Summergrad and Renȳe Binder). We completed and launched the fifth edition of DSM and established it as a “living document” under the auspices of a steering committee that can integrate changes as occasioned by emergent scientific findings; finalized plans to return APA to the District of Columbia by building a new home in a prime location near the Capitol; augmented the permanent staff of APA; revamped APA’s programs and enhanced its range of functions, focusing their emphases and orientation on the members of APA; and enhanced our relationship with the federal government to more effectively contribute to policy and legislation while advocating for increased psychiatric research funding and improving reimbursement of psychiatric services under Medicare. When insurance companies were not complying with the law, we initiated legal actions against them. Most recently we actively supported the Helping Families in Mental Health Crisis Act and 21st Century Cures Act. The latter has culminated in the first ever nominated psychiatrist—Dr. Elinore McCance-Katz—to the newly established position of Assistant Secretary of Mental Health and Substance Use in the Department of Health and Human Services. In addition, we have reversed the downward trend in APA membership for the first time in more than 10 years and seen the number of medical students entering postgraduate training in psychiatry increase by 5 percent this year.

However, it is the election of our recent series of presidents (and officers) culminating in Altha’s election that I cherish most of all, as it represents, in my opinion, the heart and soul of APA as an organization that is mission driven as well as inclusive, compassionate, and socially aware.

APA is dedicated to the advancement of psychiatric medicine for the care of patients with mental disorders. At the same time, its members are heterogeneous and composed of multiple constituencies defined not only by clinical focus and professional discipline (for example, clinicians, academics, researchers, and administrators working in the public and private sectors and specialists in such areas as adult, child and adolescent, geriatric, addiction, and consultation-liaison psychiatry), but also age, gender, race, ethnicity, nationality, and sexual orientation. Throughout its history, APA’s leadership has variably represented these constituencies in a way that reflects the evolution and directions of the field and our society.

From 1844 to 1985, the presidents of APA were white men drawn mostly from academic medical centers and universities, with substantial representation of public sector, community psychiatrists. However, in the 1970s, the leadership began to more and more reflect private practitioners and deemphasize the community psychiatrists working in the public sector. In a related trend, the leadership of state mental hospitals and departments of mental health was ceded to nonpsychiatric mental health disciplines, reflecting psychiatry’s retreat from the public health arena.

At the same time, APA began to fragment into silos with the formation of subspecialty organizations and special interest groups and caucuses. As APA became more subspecialized and factionalized, it paid a price in its cohesiveness and effectiveness as a professional organization.

But then in 1985, Dr. Carol Nadelson, the first woman president, was elected, followed by Dr. Elissa Benedek in 1990 and Dr. Mary Jane England in 1995. With the “glass ceiling” broken in the last decades of the 20th century, nine women have been elected president of APA in the first 17 years of the 21st century.

The first Hispanic psychiatrist, Dr. Rod MuɁoz, was elected president in 1998, followed in 2006 by Dr. Pedro Ruiz. In 2012, Dr. Dilip Jeste was the first Asian Indian elected President. Unfortunately, we may never know when the first gay psychiatrist was elected to the APA presidency due to the historic social stigma and fear of disclosure of sexual orientation and identity that prevailed until very recently.

While this lineage of APA leadership may have reflected the social standards and biases of American society and the medical profession during those periods, it certainly did not accurately reflect the APA membership or the patients whom they served. In this regard, however, APA was no different than other medical subspecialties and the United States at large.

The extent to which the situation has changed can be seen in the succession in APA leadership positions of previously underrepresented minorities—women, Hispanic, black, Asian, gay. Indeed, to look around the room at the Board members was to see an impressive display of talent and dedication to APA’s mission and diversity of leadership (clinicians and administrators from the private and public sectors, academics, researchers, men, women, young, old, Asian, black, Hispanic, white, gay, straight, not to mention geographic regions) that more fully reflects our membership and patient populations.

I believe these auspicious events reflect the growth of APA and its capacity for self-examination and renewal, which bode well for its future. Indeed, given what is in our power to control, the field of psychiatry and APA are on a roll. As I sat through the final moments of the Board meeting, I couldn’t help but feel proud of what APA has accomplished and in doing so reaffirming its commitment to its sacred values and mission. ■