The Long View

Officers and members of the Board of Trustees, leadership andmembers of theAssembly, councils, state associations, and district branches, Administration of the APA, the Canadian Psychiatric Association, distinguished representatives of international psychiatric organizations, and colleagues, members, family and friends: Thank you for allowingme the honor of having served this past year as the 141st President of the American Psychiatric Association. It has been both a whirlwind and deeply meaningful experience. I am particularly grateful to mywife, Randy, who has sacrificed the most, and my children and the staff of my department, all of whom have been affected and not always for the better. So it is a great privilege to come before you to share some observations about our field. Over the past year, I met with people at the frontlines of mental health care. This included parents and patients who have suffered under state budget cutbacks or in insurance-based systems that blockneeded care. It also included many psychiatrists throughout the United States and elsewhere—most unheralded—who provide essential, often lifesaving care. I have had the opportunity to meet with the faculty and residents of our great academic departments. These are, of course, at the center of our research andeducationendeavors.What is less appreciated is thedegree to which they are the bulwarks of the psychiatric care system for underserved patients, veterans, and medically complex patients. These encounters have been sources of inspiration. In speaking about our field—its science, policy issues, and longerterm prospects—I especially want to speak to those of youwho are in training or early in your careers, regardless ofwhere you live on this very small and beautiful planet. Now one of the advantages of getting older is that you sometimes see things that otherwise may not have always been obvious, and you learn to trust your instincts. And sometimes you even get comfortable enough to speak about what you see. My kids say that being President of the American Psychiatric Association was my consolation prize for not getting the job I really wanted—President of the United States. And there is sometruth to that, althoughnot asmuchas they think. Being able to see things that are not obvious to others reminds me of a story about Martin Sheen and Rob Lowe on the television series The West Wing. As you can imagine, it was one of my favorite shows, but more about that later. There is awonderful African proverb that says if youwant to go fast, go alone, but if youwant to go far, gowith others.Mybias is to lookat the long, farview, if fornootherreasonthanchange is hard, complex, and always takes longer thanweexpect.We tend to look for instant transformation, analysis, and understanding, which is 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. So I want to talk about what we can and what we have an obligation to do together. Weoftensay thatweare inadistinctiveordramaticperiod in psychiatry. Perhaps this is always trueormayappear suchat the time. As this meeting will demonstrate, we are in the midst of a profound transformation of our understanding of neuroscience, genetics, and epigenetics. That we have not yet achieved interventions based on these insights or diagnostic tests is not because we will not achieve them, but is due to 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 Paul Summergrad, M.D. 141st APA President, 2014–2015