Psychiatry and psychotherapy: past and future

The place of psychotherapeutics in psychiatry is again in question. In many ways the situation recapitulates that of the late 19th century when psychotherapeutics first came upon the medical scene. The psychiatric hegemony over psychotherapeutics was the outcome of three fierce internecine "battles", (1) the "medicalization" of psychotherapeutics (1870-1910); (2) securing the psychiatric monopoly of psychotherapeutics (1890-1930); and (3) the "medicalization" of psychoanalysis (1920-1940). Three "revolutions" in psychiatry have occurred, since the stable halcyon 1950s, that have loosened the knot which binds psychotherapeutics to psychiatry. The emergence of specific psychopharmacologic therapies, the resurgence of the laboratory tradition (behaviorism) and the community-mental-health movement have diluted the importance of psychotherapeutics in treatment and widened the therapeutic franchise. In addition, there is evidence that the function of psychotherapeutics in society is itself changing. The future of psychotherapeutics in psychiatry is discussed in light of these developments.