Presidential Address

Despite what W.C. Fields once said, it feels good to be back in Philadelphia. In these times when so much in our world is changing, returning to our roots brings strength. And some of psychiatry’s deepest roots are firmly in place— right here.

The first hospital in America to receive psychiatric patients was the Pennsylvania Hospital, which opened in 1752. Its charter provided for the “relief of the sick and the reception and cure of lunatics.”

Dr. Benjamin Rush, a Philadelphian and signer of the Declaration of Independence, is considered the father of American psychiatry.

In 1817, the Friends Asylum at Philadelphia opened, advocating the use of moral treatment.

Twenty-seven years later, in 1844, Philadelphia served as the birthplace of this association—then called the Association of Medical Superintendents of American Institutions for the Insane. It was renamed in 1892 as the American Medico-Psychological Association and in 1922 as the American Psychiatric Association.

APA has met annually since 1844, with two noted exceptions being in 1861 and 1945. Many of the annual presidential addresses reflected on the history of the Association, its progress and problems.

The longest presidential address—prior to tonight—was a 3-hour, 65-page stem-winder delivered in 1894 by Dr. John Curwin. He presented a brief sketch of the lives of the founding superintendents based on his personal acquaintance with them.

Other topics of the presidents included, in 1892, “The Dualism of Mind and Body.” (Think what research has done to that concept!)

And in 1928, President Adolph Meyer, often called the Dean of American Psychiatry, urged the granting of special diplomas for further study in psychiatry.

The Association responded to his challenge, and six years later, in 1934, the American Board of Psychiatry and Neurology was established.

So—here were are in Philadelphia, in the year 2002, reviewing the advances and regressions in our world since we met in New Orleans 12 short months ago. Few among us would have predicted the events that would befall our nation in the last 8 months. Few among us would question that our lives have quickened, and the catastrophic events’ effects on each of us have been both electrifying and numbing.

In 4 months, our nation will pause to look back on the events of September 11, 2001. We will mourn for the thousands who perished in the clear morning air from that withering assault.

While it is necessary and proper that we mourn, we also will celebrate the resilience of our country and the heroism of our countrymen, our firefighters, our rescue workers, our police and, yes—our psychiatric colleagues. In this audience are APA members from district branches in New York, the Washington area, New Jersey, Connecticut, Pennsylvania, and the uniformed services. In these and other places, our members rose to the occasion, stood and delivered the care necessary to begin the process of healing that each of our patients and the public’s health will require.

As you would expect, our profession was not without casualties and not without heroes. From the individual psychiatrist sitting alone counseling a patient in her office, to our own Neal Cohen, M.D., who walked with Mayor Giulliani through those early tumultuous events, our profession made sure that the needs of people in pain were met.

And, to our international colleagues who are here with us tonight, I cannot tell you how much your personal and your associations’ messages of support and solidarity with APA meant during those early days, so filled with despair and anxiety. Thank you, each one.

APA’s Response to September 11

As we recall the memories and heroism of those days, I want our members to hear the following:

On the morning of September 11, as smoke drifted across the District of Columbia, radio and television startled with reports that the State Department had been bombed and more planes were inbound to Washington. We heard with disbelief that attempts would be made to shoot them down because of the risk to the White House and Capitol building. The atmosphere in the District was one of disbelief and panic.

But there was no panic at APA headquarters. Dr. Mirin and the Executive Management Group and the directors of departments and others took charge of their responsibilities and helped those employees who felt it imperative to get home to care for children and other responsibilities to do so.

But Washington’s streets were gridlocked. Humvees and armed soldiers stood on street corners. There were rumors of bombings of the subway system. In this scenario a group of our dedicated staff stayed at our office to man APA’s telephone banks and, with volunteer members, pull together practical, usable information on disasters, acute stress, and posttraumatic stress disorder. This material—immediately sent to news media and placed on our web site—would be used by millions of Americans, the media, government officials, and even parents who struggled with what to say to their children.

Just 3 weeks ago, I sat on this very stage here in Philadelphia, as a guest of the American College of Physicians/American Society of Internal Medicine at their annual meeting. It gave me great pride to hear their President, Walter McDonald, M.D., thank APA for creating the information that he personally used and linked to their web site.

In the weeks after September 11, our staff continued to function in top form just four blocks from the White House. Do you remember those few weeks? Many of our staff wore jogging shoes so as not to be caught unaware again without at least a chance to demonstrate their running skills. They came to work and they did their jobs—for you and for our patients. When the anthrax issue surfaced, and it became known that the post office station that served APA headquarters was the same one that served the contaminated Capitol building, the APA staff came to work, and they did their jobs. In spite of this pressure, our staff processed continuing medical education credits, they educated Congress and the Administration, they staffed the Managed Care Hotline, and they pulled together the Institute on Psychiatric Services, meeting only 1 month after 9/11 in Orlando, Fla. In fact, APA was the first national organization to have a meeting in Orlando following 9/11. Our journals and newspapers were published—on time. There are many heroes in my eyes, but these individual staff members are my ultimate heroes.

Change in Attitudes

If there can be any silver lining in our national tragedy and challenge, it is that the public’s perception of mental illness has changed during these last 8 months. Millions of Americans, who have now experienced acute but temporary symptoms of depression and anxiety, will never again dismiss outright those with true, persistent mental illness. Local, state, and national news media, fed by factual information from the American Psychiatric Association, the Academy of Child and Adolescent Psychiatry, and other allied psychiatric organizations, provided positive and credible coverage to the mental health issues of the day. In my opinion, they educated the public and increased the public’s expectation for higher levels of psychiatric service in the future.

Leadership for the Future

Catastrophic events help us focus on the future and ask, “What next?”

I have been coming to APA annual meetings since the Dallas meeting in 1972. I may be prejudiced, but I feel the APA annual meeting is the premier medical meeting in the world. From basic science to health care delivery, through these annual meetings we have seen our future unfold before our eyes. We members can now access our scientific journals on line. At this meeting you can stop by the Internet Village in the Member Resource Center, check your e-mail, and download the entire annual meeting program onto your PalmPilot.

Electronic communications and cyberspace have allowed us to keep in touch with each other. It has permitted our Association to restructure the way our wonderful components do business—by decreasing the number of unnecessary and expensive face-to-face meetings, but keeping communication clear and unrestricted.

Advances in electronic communications, however, do have their downside—the threat to confidentiality of the medical record. We all know what can happen with one wrong keystroke. It falls to our specialty, and we have accepted that challenge, to lead in the protection of confidentiality and the doctor-patient relationship.

We will continue to work closely with Congress and the Bush Administration to assure that each of our patients has the right to determine who will see his or her medical information and to ban the sharing of identifiable medical information without prior patient consent.

We will win some of these battles, and we will lose some. We are up against some of the most powerful forces in our society. But they do not know whom they are up against. They are up against the power of the doctor-patient relationship and principles of privacy, about which Americans feel strongly.

As this meeting demonstrates, our science and our clinical effectiveness are stronger than ever before. But as our former Surgeon General David Satcher has said many times—as a nation we have the knowledge, but we lack the will.

We are constantly reminded and humbled by our challenges, such as the series of exposé articles last month in the New York Times that chronicled the pain and despair of the severely mentally ill, living in fear and in squalid, crime-ridden facilities.

Where will we get the will to create integrated public/private health care systems that will equitably and professionally deliver care to those among us with mental illness, including substance use disorders? We know that the task will be incremental. We know that we must be in it for the long haul. We do not have the answers to all psychosocial issues, but as psychiatrists, we do have a basic understanding of human behavior and motivation and an unmatched scientific knowledge base that will lead us to new treatment resources and health care delivery systems. As psychiatrists, our ethics are solid, we have a strong commitment to the individual’s and the public’s health, and we are in an ideal position to lead. However, being in an ideal position is of little value unless leaders step forward.

Through the recent decades only a few psychiatrists have led the American Psychiatric Association with the distinguished title of Medical Director of APA. During 2002, Steven Mirin will step down from that position after 5 years of effective service to our profession. Dr. Mirin has overseen tremendous change in APA. These changes include development of strategic goals, corporate reorganization, creation of an Institute for Research and Education, redirection of resources to support state-level advocacy, integration of publishing activities, enhanced fund-raising by the American Psychiatric Foundation, and relocation to an excellent new state-of-the-art facility in nearby Virginia, and these are only a few. In 2002, the mantle will be passed. APA will forever be indebted to Dr. Mirin and the legacy of the Mirin Era. Thank you, Steve, for your continuing service to our profession!

But from where will those future Medical Directors, Presidents, Speakers, and other leaders come?

Members-in-Training and the early-career psychiatrists in the audience, I speak to you. You are the most scientifically grounded, well-educated, and professionally competent physicians that have ever joined the profession of psychiatry.

Look around this room. There are psychiatrists in this hall and many more who have gone before us who have worked valiantly, with few treatment resources other than their knowledge of human behavior and psychodynamic principles and a few rudimentary medications. They are now watching you. They are watching to see how you will react to the challenges of this twenty-first century. Each generation is given such an opportunity. Now it is your turn.

My esteemed younger colleagues, you are being summoned by history to address the complex problems facing psychiatrists and people with mental illness, including substance use disorders, in the twenty-first century. I know that these are difficult times. Many of you have families to raise, bills to pay, practice expenses, and precious little spare time to give to any cause, no matter how important. But you are physicians, psychiatrists, and professionals. And professionals have duties far beyond those of a “provider.”

Professionals are dedicated to providing service and advocacy for their patients.

Professionals have specialized knowledge.

Professionals set standards and maintain them internally.

Professionals keep their eye on the long-term goals, and professionals help address society’s needs.

You are not alone. Look around this hall and on this stage. There is world-class expertise, there are mentors, there are skilled media experts, there are medical politicians, educators, researchers, and gifted clinicians eager to help and advise you—joined together in the American Psychiatric Association. Both young and senior members, you are the caretakers of our identity and our professionalism in this “consumer society” in which we live.

Tonight let us rededicate ourselves to active and constructive involvement in our professional association. It is our duty and our best hope for effective action in the halls of government and regulatory bodies. But, more important, it is our best hope for helping our patients and our society. As APA continues strong, so shall we.

Presented at the 155th annual meeting of the American Psychiatric Association, Philadelphia, May 18–23, 2002. Dr. Harding, 128th President of the American Psychiatric Association, 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 Neuropsychiatry. Address reprint requests to Dr. Harding, Suite 102, 3555 Harden St. Ext., Columbia, SC 29203; [email protected] (e-mail).