Psychiatry surely has many challenges and problems to face nowadays. Managed care seems to limit treatment options, including our opportunity to provide psychotherapy. National economic problems reduce public sector funding for our poorer patients. Stigma affects our patients and ourselves.
Yet, despite these and other obstacles, the articles selected for this Psychiatric Specialties Special Report indicate the vitality, creativity and relevance of the field. They show that the study and treatment of the mind and brain can range far and wide, even into unfamiliar ethical territory. They also show how the field can adapt to changing economic and sociocultural developments in the United States. As such, these articles should be of interest to all psychiatrists and of special interest to those interested in the specific topics covered.
For example, "Forensic Psychiatry as a Specialty" gives a clear picture of why working in that area has been controversial but necessary for psychiatrists and society. Although it emphasizes a core ethical principle of honesty, Thomas G. Gutheil, M.D., points out that it does not necessarily keep the welfare of the patient paramount. Recommendations for adapting to this important ethical challenge are succinctly made.
In another legal arena, J. Steven Lamberti, M.D., discusses how to prevent the incarceration of the severely mentally ill. Recommendations for all clinicians working with this population include optimizing pharmacotherapy, early intervention, addressing substance abuse, partnering with support systems and collaborating with local criminal justice representatives.
In "Organizational and Occupational Psychiatry," Ronald Schouten, M.D., J.D., discusses techniques and skills psychiatrists can use to make an impact in the workplace.
Finally, given the increasing aging and cultural diversity of our population, Daniel Moldavsky, M.D., provides information on how to shift our skills to patients with differing values influenced by their cultural backgrounds.
Certainly, there are other special topics not covered here, including the exciting advances in biological psychiatry. Perhaps these will be covered in ensuing years. Nevertheless, these articles provide a glimpse of the potential importance of psychiatry.