The Presidential Address offers an opportunity to say publicly how grateful I am to have had the professional stimulation, collegial support, and friendship of Canadian Psychiatric Association members from across the country, not only during this presidential year but also throughout my career. This year has been sometimes taxing, trying to juggle work responsibilities, CPA business, and family life—my employer and my coworkers have been generous in their support. To my family—my husband, 4 children, and parents—I have a special debt to repay.

And now a disclaimer: I am not an expert! From the outset I’ve been nervous about serving as president of an organization that I think has become increasingly sophisticated in its efforts to advocate for our profession and our patients. Unlike many of my predecessors, I am not a distinguished academic, researcher, teacher, or administrator. I am a general psychiatrist working in a small community where I have many roles. Such a background can, however, provide other insights into the real life experience of our members. In a culture that celebrates expertise, it is humbling to know that you aren’t one and disconcerting when others try to imbue you with that title. Of course, at home one never has to worry about developing an inflated opinion of one’s value to the public. All our children have at some point dismissed us as “not real doctors”—their understanding being that we merely spend many hours toiling over “paperwork.”

In this address, I hope to outline some of the issues facing psychiatrists as we enter the next millennium, addressing our opinions, those of our patients, and those of the general public that are reflected in public policy. I will illustrate where I see opportunities for us to close the gaps that exist between the science and the practice of psychiatry in everyday life—where as practitioners, as a professional organization,

and as citizens we can contribute to improving the mental health of Canadians. In many ways it is indeed “the best of times, the worst of times” to be in practice. Tremendous advances in research must be addressed by applications in practice—an increasingly sophisticated public demands cutting-edge care from a resource-strapped system—improved relationships within the mental health team and with the consumer are developing, but practitioners are feeling demoralized.

Depending on the day, I vacillate between high enthusiasm and teeth-grinding frustration about the state of mental health practice in this country. In my own clinical work and administrative activity, I see the same pattern. While I work hard to offer hope and comfort to my patients, even in the face of sorrow and loss, I let the equivalent of therapeutic nihilism enter into my collegial relationships. Not surprisingly, my negativity is unlikely to attract medical students to consider psychiatry as an attractive vocation, nor am I apt to provide much help to embattled administrators who are trying at their own level to sensibly manage scarce resources.

As a resident in the late 1970s and early 1980s, I suspect I was more dogmatic about what I thought I knew and what I thought my role as physician demanded I project. Today I am more comfortable with ambiguity and with sharing with coworkers, patients, and families the uncertainty that is a feature of many practice interventions. I think that is growth (although sometimes I worry that it is a sign of neglect of maintenance of competence activity).

That role of expert, able to make definitive declarations about causation, behaviour, or treatment response is one that is an imperfect fit with psychiatric practice. I am not suggesting that the standard of evidenced-based practice is necessarily further advanced in other medical or surgical specialties, but we suffer in comparison for our lack of “objective” tests of