Predicting the future is a difficult task, so I approach the topic of "APA in the new millennium" with some trepidation. We have few reliable methods for predicting the future, and the effect of social and economic change, as well as shifts in societal values and priorities, is unclear. Nevertheless, I do have a few thoughts on the subject. So, with apologies to Jules Verne, William Gibson, and others, let me get out my crystal ball.

We are in the earliest stages of the technology age. Whatever we see today is probably as primitive, or more so, than advances in transportation at the end of the 1800s. The major difference seems only that the pace of change is much more rapid. In particular, the rapid changes in information technology are just beginning to transform our field. I expect dramatic change, more revolutionary than evolutionary, in the coming decades.

The need for human physical presence for communication is no longer necessary; the increasing use of telepsychiatry is an example. Two-way television links are widely used on the Web today, and I can foresee a time in the not-too-distant future when many office visits will occur from the patient’s home. Further, I expect we will be able to use this method for continuous or intermittent monitoring both to gather a perspective on the patient’s daily life other than from the patient’s own verbal reports, or to monitor the person’s status. Of course, this information will be subject to the strictest privacy rules, unless the government decides otherwise. We obviously can’t take privacy for granted these days and will need to be even stronger advocates than we are today.

Except for unforeseen catastrophe, I wrote last summer, there is little question that computing technology will continue its exponential rate of development. The advances in "virtual reality" devices bring us close to a point when it may be moot to ask if experiences in a "virtual" environment are real or valid. Therapists are already using virtual reality devices to treat phobias, for example. Sophisticated computer-generated "avatars" may someday soon be used as "virtual" therapists or patients used for training as interactive programs become more and more sophisticated. Further, as computer logic systems advance to a point where "artificial" intelligence systems mimic human mental processes, our ability not only to understand, but also to modify mental processes will take a quantum leap.

We are on the cusp of an abrupt transition to a new, mostly human-created environment. And, as with the potential for genetic manipulation (which is also coming sooner than most people think), we should anticipate a parallel ability to recreate, and modify, ourselves mentally through advances in information technology. We know human brain–machine interfaces already exist and are already used to treat deafness and blindness. In December 1999 there were reports in the media on the use of portable brain stimulators to change emotional state in depressed patients. So much for my previous comments that such devices now existed only in the realm of science fiction.

It is abundantly clear that the control of the technology I’ve just described will likely become one of the most critical societal decisions of the information age. The ongoing political battles over medical-record privacy are only the beginning of this debate.

I can envision, though, data banks of vast patient records and characteristics to which every psychiatrist has access, and all that will need to be done is punch in new patient information in order to receive sophisticated diagnostic, treatment, and prognostic data. I assume APA will want to provide this as a member service eventually.

We know there is tremendous potential to use vast data banks in large-scale treatment matching/clinical outcome research. Perhaps our new research institute will become one of the world’s great repositories of such data. Who knows, this could become one of our best member services.

Educational uses of technology are also in the earliest stages of development. Over a decade ago, when I was chair of APA’s Scientific Program Committee, I joked to Carol Davis, one of our most senior APA staff members, that we should create an "annual meeting in a box." This was before anyone had heard of the Internet, holographic projectors, or interactive computer programs. My idea was that this would allow anyone to "attend" the meeting from home. Maybe this isn’t too far off, either. Using such technology to upgrade knowledge and clinical skills is coming right along with it.

We all know that communications within APA and among members needs a great deal of work. When we’re all hooked up to interactive wide area networks, that won’t be a problem. In fact, such networks will have a large impact on governance and conducting the work of the Association. People will undoubtedly look back wistfully to the days when APA President Tasman urged everyone to use more conference calls and e-mail and wonder whether communications could ever have really been so primitive.

As I’ve said before, we have an unparalleled set of challenges as information technology, psychiatry, and APA intersect. On the one hand, there is tremendous excitement as we explore meaningful ways of using computer technology in our research, education, and clinical missions. On the other hand, however, at some point soon, as more and more of our world is formed and modified by electronic information, we will have to face the issues I’ve just raised.

It must be apparent I’m a big science-fiction fan. It’s interesting to note that during the 1970s and ’80s, the major themes in sci-fi related to the impact of genetic engineering. As that has come to pass in reality, the focus has shifted. Now, in the ’90s, a major area for elaboration is the modification of brain function, and, thus, the mind, either by using sophisticated brain implants or peripheral devices, and the use of sophisticated robots, or androids, to mimic human beings (robots, of course, are not really such a new theme).

One of my favorite sci-fi writers, Philip K. Dick, continually investigated the nature of reality and its potential modification via technology. In his imagined universes, machines designed as simulacra of humans often show themselves to be more "human" than their flesh-and-blood counterparts. Our profession of psychiatry, placed in the role of arbiter of sanity and reality, both by virtue of our training and by societal sanction, must face the challenge of preserving the "human" in an increasingly mechanistic world. This task will occupy a more central role for us as our world undergoes the chaotic and often painful transmutation into the next iteration of the information age.

Many of the ideas I’ve written about are in my mind because of many long conversations with my son, Josh. Maybe the most important function of APA in the next millennium is to remind every member to keep talking with your kids. They clearly know more about the future than we do and really don’t mind helping mom or dad out in getting up to speed.