The Most Exciting Time in the History of Psychiatry

Allan Tasman, MD

EDITORIAL

I’m incredibly honored and excited to be starting my role as Editor in Chief of Psychiatric Times, which has become the most widely read publication for psychiatrists in the US. I look forward to continuing the visionary approach of the founding editor, John Schwartz, and his successors, Drs Ron Pies, and James Knoll, who have been committed to ensuring that Psychiatric Times and its Web site provide an unparalleled source of high-quality information aimed to assist you in your practice.

We live in what is arguably the most exciting time in the history of psychiatry. At the dawn of the 20th century, though, the themes that would occupy psychiatry in the coming century were already in evidence. One theme has been the emphasis on understanding brain pathology in psychiatric illness, building on the work of the generation of Eugen Bleuler, Emil Kraepelin, and Adolf Meyer.

Also, 1900 marked the publication in Europe of Freud’s Interpretation of Dreams, and the beginnings of the modern understanding of psychological development and our emphasis on psychotherapeutic treatments. Less well known, however, is another work on which Freud was laboring at the same time. In the “Project for a Scientific Psychology,” Freud was attempting to understand the neural basis for psychological processes. While the “Project” was not discovered or published until 1953, this century-old quest has marked one of the most important preoccupations of modern psychiatry.

What were the other preoccupations a century ago? Providing humane and effective treatment for psychiatric disorders, developing a meaningful diagnostic classification, and overcoming substantial societal forces working against rational diagnosis and humane treatment were clearly at the forefront. Building on the tremendous scientific advances of the late 19th century, the beginning of the past century marked a time of great optimism for what 20th-century science would bring to psychiatry.

We have not been disappointed, and we are all aware of the broad range of amazing advances that have occurred. We are still preoccupied with many of the same issues as our colleagues from a hundred years ago, but, of course, in ways transformed by over a century of experience and newly discovered knowledge. Social ostracism, stigmatization, discriminatory government and corporate policies, and discriminatory limits on access to and reimbursement for optimal care are but a few manifestations of these ongoing concerns. And, we are still working to develop more effective treatments based on a growing understanding of brain structure and function and an etiologically based system of diagnosis.

In 2000, we passed the 100th anniversary of the publication of Interpretation of Dreams and the writing of “The Project for a Scientific Psychology.” Freud would be amazed and gratified at the progress that has been made since his time. Advances have occurred, as we know, not only in the area of psychoanalysis and the development of other psychotherapies, but also in understanding the connections between brain and mind, which was the major focus of the “Project.” Freud himself wrote that he believed his psychoanalytic theories were only a temporary model that would continue to change with increasing understanding of the brain’s structural and functional nature.

Just over 10 years ago, the Nobel Prize in Medicine was awarded to Eric Kandel, the New York psychiatrist whose work established that the brain is continually remodeled, partly in response to developmental and environmental influences-a process we now call “neural plasticity.” Another of the most important neuroscience discoveries of recent decades is that contrary to long-standing belief, new brain cells are continually formed from stem cells in the brain. Both of these findings open many new avenues for research into brain function and dysfunction and the development of new and more precisely targeted treatments.

Advances in psychiatric research, spanning the entire spectrum of biological, psychological, and social aspects of mental processes and functions, have transformed our field and our clinical work. We are, though, only in the early years of studying underlying mechanisms of both normal and abnormal brain function and structure via direct functional imaging and sophisticated lab techniques. More exciting findings lie ahead.

We will undoubtedly, at some point, learn to influence these processes with more precision than is now possible. It is also true, however, that interpersonal experiences, such as in psychotherapy, can alter brain function in the same way as medications, as we have seen in studies of OCD and depression. Although he had been developing his ideas for many years, George Engel first published his proposal for a biopsycho-social model for medicine in 1977 in Science as a way of fostering a field that embraced an integrative approach to understanding not only what the illness is but also who the person with the illness is-both areas providing essential information for optimal clinical understanding and intervention. At that time, he likely had no way of being certain that the neuroscientific and other research advances of the coming decades would reaffirm the position that this integrative model should remain our ideal.

It is with the goal of integrating the best of our humanistic traditions with our most cutting-edge scientific advances that Deputy Editor Michelle Riba, the Editorial Board, and I approach the next phase of our work at Psychiatric Times. Our primary focus continues to be to provide an outstanding resource to improve the clinical practice of psychiatry. You are most welcome to contact me at editor@psychiatrictimes.com to let me know how we’re doing and your ideas about providing the information that you’d find most useful in your daily work.