Reports of Our Death Have Been Greatly Exaggerated

In the almost 40 years since I finished residency, there have been several predictions of the death of psychiatry. Late in the 20th century, two psychiatrists—E. Fuller Torrey, M.D., and Thomas Detre, M.D., envisaged our becoming neurologists, based on the growth of neuroscience and the limits they perceived psychotherapy had in treating mental illness. This reductionistic forecast has not come to fruition. Even as research has led to a tremendous increase in neuroscience, research also has demonstrated the importance of psychotherapies in patient care, and we have come to a greater awareness of the crucial role of psychiatric physicians in providing care.

Now, we are informed of a similar prediction from a past president of the American Psychological Association. It is tempting to speculate on his motivation or how he came to this determination, but neither matters since his prediction is so far from reality at a time when our profession continues to grow immensely in its science base, stature, and effectiveness.

Public understanding of mental disorders and psychiatry's role in providing care has never been so high. Our partnerships with national advocacy organizations such as the National Alliance on Mental Illness and Mental Health America, as well as the contributions of celebrities who have spoken openly about their illness and the success of their treatment, have helped reduce stigma, fear, and blame and have united professionals, patients, families, and the public in support of research and access to nondiscriminatory care.

Federal lawmakers view us positively. The public agrees that good mental health is as important as good physical health, and research consistently has demonstrated their connections. There is broad recognition that mental disorders are real medical disorders that can be treated effectively without breaking the bank, as demonstrated by numerous health services research studies. Even the business community has recognized that good care for its employees is not only the right thing to do, but that it enhances productivity and provides benefits that far offset the cost of care. (I will discuss our extensive efforts with the business community in a future column.) And attacks on psychiatric care, motivated by emotion and prejudice, have been successfully fended off with science and data.

Our relationships with our colleagues in the rest of medicine, through the AMA and medical specialty organizations, are extremely positive and have included their support on key issues such as insurance parity and legislation to remove the Medicare discriminatory copayment for psychiatric care. Psychiatrists are highly valued leaders in medical centers where they serve as presidents and deans; research in academic departments of psychiatry is funded and flourishing, ranging from studies of psychotherapies to cellular biology. We are welcomed in our medical communities.

With the diminution of reductionistic approaches to care, psychiatrists have a more sophisticated integration of psychotherapy and psychopharmacology. When senior psychoanalysts such as Glen Gabbard, M.D., discuss treatment, they may include not only psychodynamics, but also behavioral genetics and adaptation over the life cycle, biological markers and pharmacogenomics, as well as the use of medications. PET scans demonstrate the impact of psychotherapy, mirroring changes in behavior and mood. Although many results of neuroscience research may not yet be applicable in everyday practice, this work demonstrates the importance of a biopsychosocial approach both in patients with psychiatric disorders only and those with other medical disorders as well.

With these advances come challenges to psychiatry residency training, as faculty must address the ever-expanding knowledge base, new systems and venues of care, and the associated economics, while ensuring time for the skill development so vital to good treatment. As we define and measure competencies in residency, we must also consider ways to ensure growth, maturation, and continued integration of scientific developments. My interactions with residents during my travels as president, as well as observation of residents serving on APA components and in the Assembly, add to my optimism about the strong future of psychiatry. Nonetheless, our continued success depends on hard-nosed and nondefensive examination of our professional function, as well as the education and training of the residents who represent our future. To that end, our Board approved a new committee on graduate education, which has just begun its deliberations.

Psychiatry's health is strong. Spread the word. Work for our future.▪