Past, present, and future of psychiatry: personal reflections

OBJECTIVE: To review the past half century of North American psychiatry from personal experience and to gauge its future prospects. METHODS: An examination of the relevant literature, recollections from a long academic career, and analysis of trends. RESULTS: The pendulum of psychiatric theory continues its swing from its psychological to its biological pole; current economic forces are driving it toward reductionistic biology. The very considerable gains in the psychosocial and neurobiogical knowledge base of our field will ultimately have a potent yield in patient care once the restrictive controls on its application to service provision are lifted. CONCLUSION: The future of research in the sciences basic to psychiatry has never been more promising. How rapidly progress will occur will be a function of the resources society is willing to commit to mental health research. The prognosis for the translation of the new findings to clinical practice will depend on whether professionals can mobilize public support for quality care for the mentally ill.