Jeste Looks to a ‘Positive Psychiatry’ for an Aging Population

“Positive psychiatry”—promoting resilience, wisdom, and optimism, as opposed to merely treating symptoms—is the psychiatry of the future.

That’s what outgoing APA President Dilip Jeste, M.D., said in his presidential address at the Opening Session of APA’s 2013 annual meeting last month in San Francisco.

David Hathcox

Jeste reflected on events of his presidential year, including most prominently the publication of DSM-5. He hailed DSM-5 Task Force Chair David Kupfer, M.D., and Co-chair Darrel Regier, M.D., and noted that the revised manual involved years of work involving hundreds of individuals.

“We hope that DSM-5 will lead to more accurate diagnoses, better access to mental health services, and improved patient outcomes,” he said. “Of course, with scientific advances, it will need revisions. Science should never be stagnant, and neither should medicine.”

Jeste also remarked on the accomplishments of outgoing Medical Director James H. Scully Jr., M.D., noting that he “leaves APA in a much stronger position than when he [became medical director].” And he welcomed incoming medical director Saul Levin, M.D., saying his expertise in electronic health information exchanges and implementation of the Affordable Care Act “plus his proven leadership of large organizations will come in handy as we adapt to and take a leadership role in mental health care reform.”

Jeste also noted APA’s involvement in working to ensure that insurance companies comply with the federal parity law and in efforts to secure better reimbursement for psychiatrists treating Medicare and Medicaid patients.

Jeste drew attention to the traumatic events that occurred during his presidential year and that called for a response from APA. “We all have been deeply touched and saddened by the senseless gun violence in Tucson, Aurora, and Newtown,” Jeste said. “APA and the district branches stepped forward to provide critical help to the local communities. There has been an unfortunate tendency in some quarters to equate mental illness with violence. But we must remind others that 96 percent of the violent crimes are unrelated to mental illness and that people with mental illnesses are far more likely to be victims than perpetrators of crime. At the same time, we must improve the access to care for people with serious mental illnesses. I recently formed an APA-led coalition of physician organizations, including the AMA, that will develop recommendations for enhancing mental health care as well as reducing the stigma of violence.”

Jeste drew on his own immigrant experience to hail the diversity of the United States and of APA.

“APA is truly a microcosm of our country,” he said. “The country’s motto ‘E pluribus unum,’ meaning ‘one out of many,’ reflects on both its diversity and unity. America is not really a melting pot—it is more like a salad bowl or a cultural mosaic, in which different groups retain their uniqueness, but serve a common goal. I think the same applies to APA too. APA members differ in age, gender, ethnicity, subspecialty, type of practice, political views, whatever; yet we all are united around the common goal of promoting the highest-quality health care for people with mental illnesses.”

He concluded his address with a reflection on his experience as a geriatric psychiatrist and his belief that successful aging is not an oxymoron but a scientific fact, emphasizing that a “positive psychiatry” of the future will be essential in an aging population.

“I am convinced that life begins at age 50,” he said. “Studies show that quality of well-being follows a U-shaped curve. It is pretty high in the early 20s, then starts going down and hits rock bottom around 50—that is the time of midlife crisis. But then, people change their jobs or partners, or just their attitudes and behaviors, and the well-being starts going up progressively into their 50s, 60s, 70s, and 80s. Quality of life and psychosocial functioning depend less on physical health and more on positive psychological traits like resilience, optimism, social engagement, and wisdom….Some of the most exciting neuroscience research during the past two decades has shown conclusive evidence of neuroplasticity of aging….I expect that the future role of psychiatry will be much broader than treating psychiatric symptoms. It will seek to enhance the well-being of people with mental or physical illnesses. That is Positive Psychiatry. We will learn more about brain processes responsible for these traits, and we will seek new ways to promote resilience, optimism, and wisdom, through psychotherapeutic interventions.” ■