Author Malcolm Gladwell, in his popular book The Tipping Point,
describes a process by which dramatic changes can take place in the world in a
seemingly sudden and unexpected fashion.
He argues that change often does not occur in proportional response to the
pressure being applied, but rather change occurs when the accumulation of
pressures on a system is great enough to overcome inertia. He refers to the
point at which a system is poised to undergo dramatic change as the"
tipping point," since it is at this point that the smallest of
influences can turn out to be explosive.
Perhaps it is a stretch, but I have begun to wonder about the practice of
psychiatry and whether we are approaching our tipping point.
It seems that pressure for change is coming from all
quarters—advances in neuroscience and the application of new
technologies are challenging the way we conceptualize mental illness, health
care reform is challenging the way we provide services to our patients, and
pressure to change our relationship with the pharmaceutical industry is
challenging the ways in which we develop new therapies and educate
practitioners. That all adds up to a lot of stress on the system.
If change is to occur, the key questions become whether we are in a
position to direct this change, and do we have a vision for where we would
like to go? These are questions that APA leaders have been struggling with and
are attempting to address.
As part of this process, our immediate past president, Dr. Nada Stotland,
appointed a work group to develop a list of priorities for APA to help the
field make these transitions. The work group, led by Dr. Dilip Jeste, an
at-large member of the Board of Trustees, began the process of defining APA's
agenda for the future by organizing a focus group that met during the APA
annual meeting in San Francisco in May.
Ideas presented at the focus-group meeting and from members of the work
group were used to develop a survey for the APA membership. The survey
addresses a broad range of topics including relationships with other medical
professions, models for clinical practice, and the integration of science and
clinical evidence into training and mental health care. The "Survey on
the Future of Psychiatry" is available for members to complete, and they
can do so until September 30. An e-mail with a link to the survey was sent to
all members in early August and was resent on September 2. Members who have
not received it can contact Miriam Epstein at
Members' survey responses will be used to prioritize the work of APA.
Another effort under way to prepare the field for future challenges is a
series of town-hall meetings for members-in-training and early career
psychiatrists. Headed by Dr. Carol Bernstein, APA president-elect, these
meetings will provide a forum for participants to discuss the future of the
field and APA's role in meeting the needs of its members and the patients they
The town-hall meetings will be held in cities across the country over the
next year. The series will begin in New York during next month's APA Institute
on Psychiatric Services and will be held on Thursday, October 8, from 7 p.m.
to 9 p.m. at the Sheraton New York Hotel and Towers.
Future meetings have tentatively been planned for Washington, D.C.,
Chicago, and San Francisco, with the final meeting to be held in New Orleans
during the 2010 APA annual meeting. Residents and early career psychiatrists
interested in participating in the New York meeting can find more information
on the APA Web site at<www.psych.org/IPS>
under "New Sessions Just Added to the Program" or by contacting
Jill Gruber at
We all lead busy lives, and it is often very tempting to stand on the
sidelines and watch a scene unfold. However, if we are truly at a tipping
point, it may be worth remembering that even the smallest of influences can
have a significant impact. That is why it is vital that APA hears from you via
the survey and at the town-hall meetings. Your ideas could help determine the
future of your field and this organization. ▪