Through a Glass, Darkly? A Look at Psychiatry's Future

February 1, 2008
Ronald W. Pies, MD
Ronald W. Pies, MD

Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.

Volume 25, Issue 2

It's often said that the word "crisis" is expressed in Chinese by two characters representing "danger" and "opportunity." In truth, the Chinese word for "crisis" (weiji) is better translated as "danger" (wei) and "crucial moment" (ji).

The dangers facing psychiatry are well known, including the growing pressures of managed care; the shamefully limited access to mental health treatment in this country; and the philosophical schism (made famous in Tanya Luhrmann's book, Of Two Minds) that continues to divide biological from psychosocial models of mental illness. Still, I draw from these articles the hope that psychiatry can overcome such challenges.

Trying to see into the future can be a precarious exercise. One always risks winding up like poor Ken Olson, founder of Digital Equipment Corporation, who said in 1977, "There is no reason anyone would want a computer in their home." Yet I believe our authors have provided a reasoned and clear-sighted prospectus. Dr David S. Janowsky, in the article that starts on this page, envisions several provocative changes in psychopharmacology, while Dr James Lake will expand this view into the area of alternative therapies-certainly a subject likely to grow in importance for our patients over the next decade.

Dr Robert Michels will look ahead at trends in psychotherapy, the success of which clearly hinges on accurate diagnosis-a topic to be explored by Dr Michael B. First. As technology has burgeoned in recent years, the role of computers in psychiatry has expanded greatly, as Dr Jesse H. Wright will explain.

At the same time, psychiatry faces the challenge of underserved or "special" populations, including children (to be discussed by Dr Thomas F. Anders), women, and minorities (to be discussed by Dr Nada Stotland). Arguably, those with substance abuse disorders are also underserved in this country, and Dr Ahmed M. Elkashef will look ahead at drug abuse prevention and treatment.

Finally, one can't practice psychiatry in the Age of Terrorism without wondering what the future holds for posttraumatic stress disorder and its treatment-a topic that will be explored by Dr Robert J. Ursano.

Yes, the crystal ball is hazy. Yet, these articles encourage the view that psychiatry may continue to evolve into a humane, pluralistic, and scientifically based medical specialty, accessible to all.