A proposed vision for psychiatry at the turn of the century

Throughout the 20th century, a series of rapidly changing emphases have been prominent within psychiatry, each one dominating a period spanning two or more decades. This pattern, along with other historical trends, has contributed to both a diffusion and a confusion about what psychiatry is and what it stands for, affecting the credibility of the profession. As psychiatry approaches the turn of the century, it is critical that psychiatrists and organized psychiatry define and agree upon a coherent vision that will serve as a foundation for a shared understanding with others regarding what the profession represents. Five principal themes are discussed here, emanating from both past and recent history, that can provide this definition to all concerned. The adoption of a biopsychosocial model by all psychiatrists regardless of personal areas of interest or emphasis is the first building block and needs to be coupled with strong support for the continuing evolution of a scientific base and the scientists who are pursuing it. Healthcare reform and the pressures from other nonmedical professions that have reshaped psychiatry's "marketplace" require that a third theme revolve around a reshaping of psychiatry's relationship with the rest of medicine and psychiatrists' interactions with their medical colleagues. Finally, a new set of liaisons with our patients must be built through a redefinition of professional values and an enhanced emphasis on patient rights and responsibilities that will empower our patients to act as our strongest supporters.