Presidential Address: A New APA for a New Century

This year has shown that we psychiatrists are not complacent about the future that others had planned for us. We are the masters of our own future and have taken the steps to have not only what we and our patients need but also what we deserve.

My friends, we are at the doors of a promised land in which our patients make their own decisions, we build a new medical reality, and our patients can and do obtain the best attention and treatment.

Last year I said that today I wanted to be long in achievements—I didn’t say I would be long in words.

A powerful Board of Trustees and a vigorous Medical Director have brought impossible dreams into immediate realities. We have looked at the endeavors of the clinicians and undertaken the necessary steps to help each clinician in providing the best care to our patients. We have started an emphasis on translating research findings into useful information that can be put to good use on the front lines where clinicians win our victories. At this meeting, the National Institute of Mental Health, the National Institute on Drug Abuse, and the Substance Abuse and Mental Health Services Administration have tracks that widen the horizon of the treating psychiatrist.

Last year we had appointed a Strategic Planning Task Force. Today we are implementing its recommendations. The final outcome will be a fearless and powerful APA.

Last year we appointed a Task Force on Quality Performance Indicators. Today we are telling all listeners that we psychiatrists are the owners and judges of excellence in psychiatric practice.

Last year we were still in the midst of the Eist revolution, in a rebellion also pursued by Herb Sacks against the impositions of managed care companies acting as agents for the business community. This year, with much help from Mary Jane England, we have established a direct link with the business community. We can demonstrate that we increase productivity by protecting health.

Last year we dreamed of psychiatrist-sponsored groups challenging the oppressive tenets of the ­managed care companies. This year has seen the consolidation and rapid growth of psychiatrist-sponsored networks.

Last year we planned on opening the APA programs to all the members. This year, at this annual meeting, we have many caucuses and forums organized, led, and controlled by groups of APA members.

Last year the APA members approved our international membership. This year we have close ties with the World Psychiatric Association. With the help of President Norman Sartorius and Secretary General Juan Mezzich, we are working on joint membership and international standards for basic psychiatric training, continuing education, and international certification. We want to ask the universal psychiatric community to join us in helping the distressed peoples of the world. The tragedies in Kosovo, Indochina, Central and South America, and many other places tell us that psychiatry can be great only if it looks at the plight of those who have no powerful defenders.

Last year we planned to devote this annual meeting to the clinician. This year we have literally hundreds of activities that honor the greatness of the psychiatric ­clinician.

Last year APA was trying to define its future. This year we have defined the future of APA. By doing so, we have created the APA of the future. We have departed from the past to build on our own fantasies of power and limitless energy, knowing that the main difference between fantasy and reality is the determination to transform unacceptable choices into new centers for autonomy and strength.

This thinking has led us to create APIRE (like AFIRE), the American Psychiatric Institute on Research and Education. APIRE will be the center for scientific pursuits and excellence in training in the decades to come.

This thinking has led us to create a new APA. A task force led by President-Elect Dan Borenstein is working on the incorporation of this member-oriented APA, of which he will be the first President in the year 2001.

This thinking has led us to buy, sell, barter, create, and combine, so that now we have consolidated all of our assets. We are making sure that in the not-too-distant future we can assert that we have an APA that is financially solvent and independently strong.

Contemporary events show that our knowledge and skills are badly needed at home and abroad. As we look at the Columbine shootings, we are prepared to tell the country that we are willing and ready to confront and debate issues related to unnecessary tragedy. We want to educate the public on how America can invest in its youth to produce well-adjusted, productive, and happy citizens. We are prepared to join parents, teachers, and communities to do our best in raising our children, while we help in identifying those at risk for violence and other destructive behavior.

I said last year that I am among those who believe in the social mission of medicine. I believe that those who have the least deserve the best. To provide for that, I have helped in the mobilization of the minorities, the underrepresented, the gay and lesbian psychiatrists, the community psychiatrists, and all psychiatrists to provide services in all settings, including the inner cities, the rural communities, the schools, the university centers, the prisons, the shelters for the homeless, and all other places where our patients expect the best from our efforts.

I am about to be promoted to the position I have always cherished: I am going back to being a psychiatric clinician. In this moment of remembrance, I want to recall that 35 years ago I arrived as an immigrant, whose future has now been realized thanks to your efforts and to your generosity. I want to render tribute to my family, to my wife, to my children, to my predecessors, to my teachers, to my colleagues, and to many others, including the many patients who have confided in me through the years. I want especially to honor my immediate predecessors, Drs. England, Eist, and Sacks, who opened the doors to the realization of many dreams.

For most of my life in APA, the organization was largely modeled by our titan of the second part of the twentieth century, Mel Sabshin, to whom I want to pay special tribute.

Nothing that happened this year would have happened were it not for the creativity, the good judgment, the ideas, and the endless energy of Steve Mirin, a colleague, a friend, and an advisor of enormous stature. He has the backing of an exceptional APA staff whose efforts make us shine.

Allan Tasman has been a co-thinker, co-planner, co-organizer, and co-executor of my plans and dreams. His clear intelligence, his steady pulse, and his lofty goals have been a constant source of strength. I leave APA to him in battle formation for the next century.

As I look at the people sitting with me today, and at the contributions of Dan Borenstein, Donna Norris, Al Herzog, Richard Harding, Paul Appelbaum, Michelle Riba, Maria Lymberis, and the wonderful trustees who served with us this year, I can see a strong chain of powerful APA leadership well into the next century.

My friends, we are ready for the challenges of a ­limitless future.

Presented at the 152nd annual meeting of the American Psychiatric Association, Washington, D.C., May 15–20, 1999. Dr. Muñoz, 127th President of the American Psychiatric Association, is in private practice and is Clinical Professor of Psychiatry, University of California, San Diego. Address reprint requests to Dr. Muñoz, 3130 Fifth Ave., San Diego, CA 92103