Response to the Presidential Address: 21st-Century Psychiatrist

As I begin my year as the 130th President of the American Psychiatric Association, I will make a promise to you. We built this association on professional values and dedication to the welfare of our patients and members, and I intend to keep it that way. Each generation of psychiatrists has the opportunity and obligation to make an impact on the heavy burden of mental illness. Now, it is our turn.

I have had the honor of sitting on this stage seven times. Each time, I have been inspired. Inspired as I look at the officers of the Board and Assembly. Inspired by Past Presidents who have helped shape our association—Past Presidents who remain active in the APA, active in their private practices, and active as medical executives of major medical programs and institutions across America; active as advisors to federal, state, and local governments; as editors and counselors to peers, patients, friends, and families.

But, with all due respect to those on this stage, it is you, the members of the APA, in the audience of this great hall, who truly inspire me. By your example of patient care and psychiatric administrative duties, you continue to make a difference in the day-to-day lives of your individual patients and a difference in the private, academic, state, and federal treatment programs in which you serve. We, on this stage, are in awe of you! We know that through your individual efforts, sometimes providing care within underfunded mental health and correctional facilities, you have somehow maintained your professional standards. Why? Because you are a professional, a physician, a psychiatrist. I know I speak for every person on this stage in saying thank you for what you are doing.

As Dr. Mirin mentioned, since 1900, four generations of my family have been psychiatrists and members of the APA. My great-grandparents Drs. George and Phoebe Harding both became physicians in the 1870s. Their progeny have produced 27 physicians, including 13 psychiatrists. My grandfather George Harding was a physician. His brother Warren was the only Harding male for three generations to not become a physician. He chose instead to become a newspaper editor and increasingly became involved in state and national politics.

The second generation included three psychiatrists who, with my two oldest siblings, George and Herndon, built a nationally known psychiatric hospital in Columbus, Ohio. The third generation has two psychiatrists. The fourth generation has two APA members, the youngest being Dr. Mary Ann Schaepper, a child fellow at UCLA. As you can probably tell, I am proud of my physician ancestors and relatives. But that is not the point of this brief family album. For each of those relatives who chose medicine and psychiatry, there were family members and significant others who have unselfishly given the support necessary for each physician to carry out the heavy load of a medical practice. We psychiatrists receive rewards for practicing our profession, but we psychiatrists know who the real heroes are.

If you will indulge me for a moment, I would like to introduce some of my family who are present tonight from Florida, Ohio, California, and the Carolinas. I see them as representing families and friends of other members who are also here in this audience. Some of my family present include my siblings and their spouses, Dr. George and Joan Harding, Dr. Herndon and Belinda Harding, Dr. Russell and Ann Hoxie, Dr. Warren and Barbara Harding; my nephew Dr. Herndon Harding, Jr.; my niece Dr. Mary Ann Harding Schaepper. In addition, I am most proud to introduce my wife, Dr. Sally Harding and my daughter Katherine Harding Johnson, L.C.S.W. My son Lt. Richard Harding, Jr. could not be here because of special alert status of his company at Fort Campbell, Kentucky.

I now ask that all family members and significant others in the audience please rise and receive the gratitude of a grateful profession.

This annual meeting is the greatest show on earth. We will have 17,000 registrants from every state and scores of nations. We are honored by the presence of officers from other psychiatric organizations from South Africa to Japan, from the European Union to India. I add my respect and welcome to each of you.

I also add my congratulations to President Dan Borenstein for a remarkable year of progress and dedication, to Phil Muskin along with Ed and Janice Foulkes and the APA staff who continue the tradition of scientific program excellence, unsurpassed in the medical community.

This is the first annual meeting of the new millennium. The last decade of the prior millennium was pretty tough on all of us. We struggled with funding cuts in public and private programs. We saw efficient and effective systems of care dismantled by economic forces never before seen in medical circles. We continued to experience the bone crushing pain of stigma, prejudice, and discrimination against our patients and our profession. So what have we learned? What has been and what should be our response? We have learned what passivity does to our patients, our profession, and our self-esteem. Many psychiatrists still plead, “Just leave me alone and let me treat my patients.” You know, that just doesn’t work anymore.

There is too much to do. There are populations of patients who are underserved. There are disparities that exist because of geographic location, race, and other factors that we as physicians can no longer tolerate.

As we enter the 21st century, we need to do a quick self-check. In the 21st century, will people with mental illness get the treatments they need? Are we setting and living high professional standards? Are we building a sustainable infrastructure for training residents and medical students to be scientifically competent with the highest professional standards? Are we doing all we can to assure our patient’s rights to confidentiality of their medical information? Are we developing research infrastructure that will propel us into our future? Are we clear communicators with our patients and society? Are we businesspersons, or are we professionals?

It is a new time for all of us, this first decade of the millennium. We stand on the shoulders of psychiatric giants who preceded us. We look with envy on the budding careers of residents who have knowledge and treatments that my grandfather could not even dream of. We and they must be free from a decade of remorse and destructive policies that have damaged much of our identity. We must be free to build new systems of care that maximize patient choice and enhance the doctor-patient relationship. Thanks to many of the psychiatrists on this stage, we as a profession are free to fight in the social and political process because of the APA’s reorganization. Free to advocate for patients and professionals and to join political battles from which we had to shrink in the past.

We must be free to blow our own horn. In the last decade, we doubled the research dollars at NIH. In the last decade, psychiatric research in medical schools has risen from eighth place to second, trailing only internal medicine. We are invigorating the training of psychotherapies in our residency programs. We are recruiting a disproportionate share of minority and underrepresented medical school graduates into our training programs and are recruiting the highest quality international medical school graduates. We are working to assure that our members will be the most clinically competent physicians among all specialties. We are not afraid of evidence-based practices. We are not afraid of being evaluated. We are professionals, and professionals self-regulate. Professionals stay competent.

Let there be no further talk of early retirement. We have too much to do. We welcome other mental health professionals to join with us in delivering coordinated care to our patients, but we have a unique role. We are physicians. We will not allow the trivialization of a medical education. We accept criticism from peers and society, and we learn from it, but we will not allow members of the “Flat Earth Society” to turn back the clock on science and diagnostic nomenclature. We will not allow them to defeat us in the courts or the court of public opinion. For too long we have lived with discrimination as a fact of life for our patients. We ask no special status. Just give our patients the same benefits as medical/surgical patients. We can’t ask for more. We won’t accept less.

Doctors have traditionally been lousy politicians. That stereotype must end tonight! I have always assumed that good data and good intentions drive public policy decisions. Wrong! If we are to assume our rightful place in the driver’s seat of public mental health policy, we must have good data and increased coalitions and be proactive in our agenda. We know what is best for our patients and for the systems of care that help us provide that care. We can’t go back to the 1970s. We will go forward. Advocacy is needed. Advocacy is an intervention for our patients.

Next year we will be in Philadelphia for the 155th annual meeting of the APA. The theme will be “The 21st-Century Psychiatrist.” It is fitting that we will be in Philadelphia. Philadelphia is the home of Benjamin Rush, M.D. Dr. Rush was not a perfect man. He was a physician in the 18th and 19th centuries, a friend of George Washington, who was willing to roll up his sleeves and roll in the mud of politics to defend his country and profession. I am proud that when the Declaration of Independence was passed down to Dr. Rush, he signed on the dotted line. I have always wondered if I would have had the courage to do the same.

I would like to think that Benjamin Rush, if around today, would talk to us about our duty as professionals and citizens. I think that he would remind us that it is our duty as professionals to serve our patients while, in the business model, providers satisfy the consumer. Professionals serve their patients. Providers satisfy the consumer. Which way, APA?

We have a duty to serve our individual patients and improve the public’s health. We have a duty to support the politicians who risk their careers to support our patients’ needs. Thank goodness for politicians like Representative Roukema of New Jersey. We have a duty to forge new alliances with our patients and their families. We have a duty to resist systems of care that undermine the doctor-patient relationship and give incentives for withholding care. We have a duty to continue to support the common good of excellent care to all our patients and to the residents of this country who happen to have a mental illness. We have a duty to join hands with our global brothers and sisters to help standardize our nomenclature and deliver the highest quality of psychiatric care throughout the world.

If not the APA, who? We have a duty. This great association always does its duty!

Thank you, and I look forward to serving our patients and members in the coming year. Enjoy this wonderful annual meeting!

Presented at the 154th annual meeting of the American Psychiatric Association, New Orleans, May 5–10, 2001. Dr. Harding is Professor of Clinical Psychiatry and Pediatrics at the University of South Carolina School of Medicine and Vice-Chairman for Clinical Affairs in the Department of Psychiatry. Address reprint requests to Dr. Harding, 3555 Harden St. Ext., Ste. 102, Columbia, SC 29203; rharding@ richmed.medpark.sc.edu (e-mail).