Continuity and Integration

By Harold I. Eist, M.D.
APA President

APA commitment to international psychiatry reaffirms that our Association is the largest, oldest, and most powerful professional group in the world advancing education, research, and high-quality care. Noblesse oblige? Certainly not. Colleagues abroad in many nations have made substantive contributions to our field that have benefited suffering patients in our own nation. The character of mental illness respects no borders, respects no systems of government, respects no ideologies. This is my 24th and final presidential column. I have enjoyed communicating with you through my columns, and I have been deeply gratified by your strong, largely positive responses to them. Whether you agree with my columns or not, it is clear they were widely read.

It is the responsibility of the president to maintain continuity of leadership. During my presidency, I carried forward and supported programs initiated by previous presidents and Boards of Trustees. Presidents following me will do the same, in addition to adding their own initiatives to assure the ongoing progress of our Association. You have entrusted your presidents with awesome responsibility, and they know it.

Dr. Herb Sacks will be, after you read this, assuming the responsibility, mantle, gavel, and medallion of office. He will serve you well as an articulate, strong advocate for our patients and principles. Dr. Rodrigo Munoz will actively and forcefully continue our tradition of advocacy as president-elect. Under their leadership, and that of leaders to follow, I am confident we will remain the preeminent patient advocacy professional organization. They will both battle for service to our populations in need, comprehensive education, and a continued expansion of our formidable but essential research endeavors, as will other Association officers at every level.

I will continue my activities in service to our patients and our organization and continue my vigorous functioning as a public educator, working toward the goal, which is coming ever closer, of fully engaging the empathy of the public for those suffering from mental illnesses. Already a formidable force, with an aroused, empathic public behind us, we will be indomitable.

I have been heartened during my presidency by your generous support and the support of the Board of Trustees, the Assembly, and the APA staff. We work together for the good of those we serve. During my two years as your president-elect and president, I heard a great deal about the lack of integration of our field. The division between the biopsychiatrist and the psychodynamic psychiatrist is one that has been frequently discussed. Clearly, we have strong advocates for many modalities in our field. Clearly, this constitutes true eclecticism, individuals deeply involved in areas that they bring to the field, as contrasted with superficiality, which is a light overview of many different areas, with no special investment or in-depth knowledge in any one area.

Much of the tension I witnessed between biological and psychodynamic orientations was not over control, but reflected intense efforts at integrating complex aspects of our overall discipline.

This is the way we do things in America and American psychiatry--strong proponents of differing perspectives promote integration through heated, at times challenging, discussion and debate. The demands on psychiatrists for integration, given our phenomenal knowledge explosion, are truly enormous. However, we have always been the integrative discipline par excellence, with pressure to integrate far greater than pressure to disintegrate. We have, through our history, moved in the direction of stabilization. Regardless of perspective, our strong advocates of points of view understand the added value of combined approaches and comprehensive knowledge to those we serve. We understand, too, we have much to learn and that we need every helpful modality currently available and more if we are to increase our effectiveness.

These struggles do not disturb me. They are part of the creative ferment of our field, and I have confidence that the difficult but ultimately rewarding, dynamic process of integration will continue over the coming decades, as a reflection also of our dedication to, and understanding of, the importance of continuity.

(Psychiatric News, May 16, 1997)