Starting a New Presidential Year With Pride

What a great gift it was to begin my presidential year by being with the APA family—members, staff, and loved ones—in San Francisco, our second chance to be together for the Annual Meeting since the start of the pandemic. Surely, one of the silver linings of that great tragedy is that we cherish so much more the ability to meet together in person.

I am excited to be embarking on this adventure with you, and I am buoyed by the support of my predecessor, Rebecca Brendel, M.D., J.D., who laid out for us during her presidential year a Roadmap for the Future of Psychiatry. We have a lot of work to do.

As a gay man, I am proud to celebrate June LGBTQ+ Pride Month with you. We have so much to be proud of—just 25 years ago, same-sex marriage was largely unthinkable. The Netherlands became the first country in the world to legalize same-sex marriage in December 2000. Since that time, nearly 30 countries have done so. It’s a significant milestone that made my own marriage possible. I hope that some of you had the pleasure of meeting my husband, Lukas Hassel, when we were in San Francisco.

Yet despite these advances, LGBTQ+ people face old and new challenges every day. The “culture wars” have inflamed tensions and exacerbated prejudice against sexual minorities. Mental illness has disproportionately affected LGBTQ+ communities. Depression and anxiety disorders are about 1.5 times higher in LGBTQ+ populations than their straight or gender-conforming counterparts. The “minority stress theory” may explain some of this: Members of sexual minorities are more likely to be the victims of discrimination and strained by the expectation or perception of discrimination and by internalized self-hatred.

It will be a goal of mine to work to ensure access to psychiatric care and addiction treatment for LGBTQ+ individuals and their partners and loved ones. I also want to help focus attention on gay youth. The Trevor Project’s 2022 National Survey on LGBTQ+ Youth Mental Health found that nearly 1 in 5 transgender and nonbinary youth attempted suicide, and LGBTQ+ youth of color reported higher rates than their white peers.

These commitments fit well into my presidential theme for this year, which is twofold. As an addiction psychiatrist, I would like to highlight the work of addiction psychiatry, to emphasize to policymakers and to the public at large that treatment for substance use disorders and the behavioral addictions works—especially medication for opioid use disorder (MOUD), which includes appropriate use of psychopharmacology along with psychosocial treatments. I will be focusing especially on four addictions that are highly prevalent—vaping, opioids (often used with stimulants), alcohol, and technology. For too long we have tended to separate addiction and mental illness—as if they were not related. But addiction is a brain disease, exacerbated by psychosocial stress: Brain imaging studies graphically reveal the changes that occur when people use addictive substances; they also graphically reveal the positive changes that occur when people recover.

I also want to devote this presidential year to energizing the public at large about the value and importance of psychiatric treatment and about the important role that nonprofessionals—parents, teachers, faith leaders, employers, caretakers of the elderly, anyone anywhere—can have in promoting mental health. Helping friends, acquaintances, and loved ones find the care they need can be deeply gratifying. The “first step of the first step” in helping someone in need find solutions to their problems and relief from emotional pain is often taken by a spouse, friend, or relative.

The COVID-19 pandemic focused attention on mental health and illness in an unprecedented way. And there is a new and growing excitement about psychiatry: For 12 straight years the number of medical students matching into psychiatry has increased. We are now a coveted professional identity!

Let’s build on this excitement.

It is a great privilege to be your president, and I am looking forward to advocating for you, the profession, and our patients. I’m also looking forward to opening up a discussion with the general public about how all of us can build a mentally healthy America. ■