“The best indicator of the future is looking at the past,” Sidney Zisook, MD, told attendees of the Annual Psychiatric Times® World CME Conference™. Dr Zisook spoke to the future of psychiatry in the Educator of the Year Lecture.
Sidney Zisook, MD
“The best indicator of the future is looking at the past,” Sidney Zisook, MD, told attendees of the Annual Psychiatric Times® World CME Conference™. Zisook, director of the University of California, San Diego Residency Training Program and a distinguished professor of psychiatry at UCSD, spoke to the future of psychiatry in the Educator of the Year Lecture.
Zisook grounded attendees by sharing a brief history of psychiatry, beginning around 2000 BC. The prevailing psychiatric theory was “eat this root.” Over time, humans and psychiatric treatment theory evolved. Around 1000 BC, eating roots was considered heathen and prayer was the answer to psychiatric ills. Fast forwarding through time, mental health care professionals moved to potions circa 1850 AD, pills in the 1950s, and then the Prozac revolution and more effective pills in 1985. As we hit the 2000s, we heard, “That pill is artificial. Here, take this root.” So, he posed, perhaps the future is really just a reflection and refinement of the past.
To further explore the future of psychiatry, Zisook turned to colleagues across the country and asked them about their hopes, fears, and predictions. Among the common themes were the prediction that the field will grow as a specialty, as noted by Joan Anzia, MD, vice chair for education in the department of Psychiatry and Behavioral Sciences at Northwestern Medicine. Indeed, Zisook noted that there are more residents choosing psychiatry as a specialty, leaving less room for international graduates.
Sheldon Benjamin, MD, interim chair of the department of psychiatry at the University of Massachusetts Medical School, said he hopes the field will increasingly work with case managers and primary care physicians to provide new opportunities for prevention, screening, and decreasing stigma. Again, Zisook felt psychiatry was moving in the right direction with collaborative and integrative models of care.
In his exploration, Zisook also looked to The WPA-Lancet Psychiatry Commission on the Future of Psychiatry for guidance in imaging the future of psychiatry. Although the commission examined 6 areas, Zisook focused on 2 of them that he felt spoke to the heart of psychiatry: the patient and treatment and training the psychiatrist of the future. He imagined psychiatrists will become team leaders, as care extenders help address the need for care and make up for shortages in psychiatry manpower. Technology would continue to play an important role in care. From smart phones and apps that allow patients to monitor and record their symptoms in between visits to telepsychiatry, he noted the digital world can help improve delivery of care and outcomes. And while Zisook said personalized medicine will remain an aspiration, the human elements (eg, cultural sensitivity and strong therapeutic alliances) will remain central to the field’s successes.
In psychiatric training, Zisook said it is imperative that the field embarks on cutting edge research and pursues innovative treatment while prioritizing patient narratives and the doctor-patient relationship to continue to attract and retain top notch talent. Similarly, he said burnout must be addressed, with an emphasis on wellness. It is important to foster team activities and connectivity, he explained. There are too many clinicians who suffer from depression and addiction, and access to care must be enhanced, including for trainees. Zisook also noted the fear of documentation when seeking help must also be addressed as well as the lack of time cited as a reason for not seeking help.
After considering the fears and hopes for psychiatry, Zisook said the field needs to learn from its failures, learn to persist, and learn humility. He quoted Michael Jordan:
I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. Twenty-six times I’ve been trusted to take the game-winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.
Ultimately, he reminded attendees, the past is not so much different from the future, and 2030 is likely to be similar to (as opposed to different from) 2020. Still, he said he believes there will be at least 1 major breakthrough treatment that nobody has yet to imagine. And, he concluded, “Psychiatry will continue to be a rewarding and essential calling.”
The Annual Psychiatric Times® World CME Conference™ is being held October 15 - 17. Next year’s conference is scheduled for September 30 - October 2, 2021, in San Diego.