BACKGROUND Despite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration. METHODS The historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment. RESULTS It is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression. CONCLUSIONS It is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.

中文翻译：

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社会不平等、科学不平等和精神疾病的未来。

背景尽管五十年来旨在推进精神疾病的病理生理学和治疗的研究日益精妙，但结果并未达到预期。诊断仍然基于观察、临床病史和过时的诊断系统，该系统强调疾病特异性的历史目标。精神药物仍然基于几十年前开发的分子靶点，疗效没有提高。已经提出了许多生物标志物，但没有一个具有必要程度的敏感性和特异性，因此在临床上没有用处。精神病学明显缺乏进展，需要探索。方法 回顾了精神病学的历史目标，包括与医学同等、注重诊断的可靠性而不是有效性，以及强调以牺牲社会经济问题为代价的还原论。托马斯·皮克蒂 (Thomas Picketty) 等人的数据表明，我们未能推进临床护理，部分原因可能是 20 世纪 70 年代开始的社会和经济不平等加剧，部分原因是我们无法超越特定医疗模式。疾病和治疗。结果本文证明，疾病和治疗特异性的历史目标不仅阻碍了精神疾病诊断和治疗的进步，而且与社会经济不平等的迅速加剧相结合，导致了结果较差和死亡率上升包括精神分裂症、焦虑症和抑郁症等多种疾病。结论 建议精神病学应认识到社会经济不平等的事实及其对精神障碍的影响。鉴于大脑的复杂性，强调诊断和治疗特异性的医学模型可能不适合大脑的研究。科学不平等的加剧，数十亿美元分配给连接组学和遗传学，可能会转移人们对改善临床护理需求的注意力。不幸的是，那些患有精神疾病的人的未来前景似乎很暗淡。