Psychiatry and APA are preparing for changing times—health system
reform, new expectations around conflicts of interest, the use of health
information technology, comparative-effectiveness research, and the challenge
of operating under new fiscal constraints.
APA President Nada Stotland, M.D., presents her Opening Session address
at APA's 2009 annual meeting last month in San Francisco.
Credit: David Hathcox
In her address at the Opening Session of APA's 2009 annual meeting in San
Francisco, outgoing APA President Nada Stotland, M.D., recounted APA's
achievements in the past year, ranging from addressing relationships between
the Association and the pharmaceutical industry to reorganization of the
component structure to make APA a more streamlined and nimble
And she asserted that in the teeth of stigma and opposition from various
quarters, psychiatry has much to celebrate.
"Our skills are unique and precious—medical and psychological
knowledge, communication and compassion—all in the service of healing
some of the most devastating diseases that afflict humankind," she said."
We are brain doctors and doctors of emotion and cognition. We chose to
pursue medical and mental health training. We dissected cadavers. We attended
operations, births, and deaths. We spent long nights at the bedside. When we
could not save our patients, we comforted their families....
"Psychiatry is the medical discipline that encompasses the body and
the soul," Stotland continued. "We understand our patients'
physiology, and we share our patients' burdens of guilt, grief, and anxiety.
We help our patients call on those sources of strength and meaning that not
only alleviate psychiatric symptoms, but make life worth living."
Stotland said that enemies of psychiatry, including the Church of
Scientology, have distorted the image of the profession, and she noted that"
no other medical specialty has an entire organization dedicated to its
She cited several individual psychiatrists by name whose exemplary work
represents the "real psychiatry and the real APA."
These included Surinder Nand, M.D., who founded a treatment center in
Chicago for Asian women immigrants who have experienced domestic violence;
Anna Holmgren, M.D., who left her home to provide psychiatric care to victims
of Hurricane Katrina in New Orleans; Carl Bell, M.D., who has worked on
violence prevention in Chicago; Francine Cournos, M.D., who has done much to
help the homeless in New York City; Marshall Forstein, M.D., who has provided
psychiatric care to AIDS patients; Arshad Husain, M.D., who has worked
extensively with victims of the trauma of war; Jeffrey Akaka, M.D., who has
fought the psychologist prescribing wars in Hawaii; and Jack Drescher, M.D.,
who has worked to educate reporters and the public about sexual
Stotland also used the occasion to assert that psychiatry has a voice in
addressing social problems.
"We can do more to improve the health of disadvantaged populations by
providing safe communities, good jobs, and education than by treating the
people who get sick because they are uneducated, unprotected, and
unemployed," she said. "We have an obligation to use our expertise
and our position in society to create social conditions that promote
"That is why we support the rights of people who are gay to marry and
raise children. That is why we take the position that each woman is the best
judge of whether to have an abortion or a baby. That is why we oppose
participation in the interrogation of detainees.
San Francisco's cultural diverstiy was spotlighted in the Chinese lion
dance that closed the Opening Session.
Credit: David Hathcox
"And that is why I told a reporter from Parade magazine that
putting children in the adult penal system is just plain wrong," she
Meanwhile, political and economic changes present challenges for American
medicine and psychiatry. She reiterated the efforts APA has made to respond to
concerns about conflict of interest, such as beginning a process to eliminate
industry-supported symposia at APA meetings.
"We are equally scrupulous as we develop the DSM-V,"
she added. "We demanded an unprecedented level of disclosure and
divestiture from the broad array of clinicians, researchers, and
epidemiologists working on DSM-V.... I don't know what DSM-V
is going to look like, but I do know that we have spared no expense, time, or
trouble to make it the best possible tool for both clinicians and scientists.
After the debates, after the decisions, we will need to come together and make
peace with DSM-V.
"Don't let our enemies use doubts about the DSM as a weapon
to undermine our profession," she added.
But the most pressing challenge—and the greatest
uncertainty—lies in the need to reform the nation's health care
"The failure of the richest country in the world to provide medical
care to everyone is wrong," Stotland said. "Job loss,
foreclosures, dislocation, and precipitous declines in the values of
investments have magnified existing health care problems and disparities. The
high costs of our fragmented system are sapping the strength of our
Stotland made it a goal at the beginning of her presidential year to
sponsor several venues for educating members about options for health system
reform, such as a "debate" that was held at last year's Institute
on Psychiatric Services between proponents of a single-payer system and those
supporting the AMA's proposal of market-based reforms and tax credits.
"Most of you want a single-payer system—but not all of
you," she said. "Shall we stay out of the fray for fear of
offending our minority or speak up on behalf of our majority? Let your
leadership know what you think."
She vowed that APA will be part of a debate that will ultimately lead to a
better, more efficient, and equitable health care system.
"We will replace the fragmented and wasteful system that wastes our
time and money, lands our patients in jails or on the streets, and lets them
die 25 years earlier than they should, with one-stop, coordinated, consistent,
health care by a team that includes us and pays us fairly and promptly,"
she declared. ▪