This article casts a critical eye over the development of American psychiatry from 1980 to the present. It notes the rapid decline of psychoanalysis that followed the publication of DSM III; the rising influence of genetics and neuroscience; the re-emphasis on the biology of mental illness; and the collapse of public psychiatry that accompanied deinstitutionalization. It argues that while genetics and neuroscience have made scientific progress, the clinical utility of their findings to date has been very limited. The fifth edition of the DSM was supposed to base itself on this new science but that proved impossible. Diagnosis remains purely phenomenological and controversial. One of the ironies of research on psychiatric genetics is that has failed to find either a Mendelian origin of schizophrenia and depression or to validate the importance of hypothesized candidate genes. Genome-wide association studies have instead uncovered risk factors for major mental illnesses, but these overlap considerably, and the genetic associations are not dispositive. Most of those who carry these genetic variants do not develop mental illness. The status of psychopharmacology since the mid-1950s is scrutinized, as is the influence of the pharmaceutical industry on contemporary psychiatry, and the implications of its recent decision to abandon work in this arena. The paper concludes with an assessment of the crisis that it contends confronts contemporary American psychiatry: its overemphasis on biology; the urgent questions that persist about diagnosis and therapeutics; concerns about the directions of future research; and its inability to reduce the excess mortality that plagues the mentally ill.

中文翻译：

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新千年的美国精神病学：批判性评价

本文对 1980 年至今美国精神病学的发展进行了批判性的审视。它指出了 DSM III 出版后精神分析的迅速衰落；遗传学和神经科学的影响力日益增强；重新强调精神疾病的生物学；以及伴随去机构化而来的公共精神病学的崩溃。它认为，虽然遗传学和神经科学取得了科学进步，但迄今为止其发现的临床效用仍然非常有限。DSM 第五版本应以这一新科学为基础，但事实证明这是不可能的。诊断仍然纯粹是现象学的并且存在争议。精神遗传学研究的讽刺之一是，既未能找到精神分裂症和抑郁症的孟德尔起源，也未能验证假设的候选基因的重要性。相反，全基因组关联研究发现了重大精神疾病的危险因素，但这些因素有很大重叠，而且遗传关联并不具有决定性。大多数携带这些基因变异的人不会患上精神疾病。自 20 世纪 50 年代中期以来精神药理学的地位、制药业对当代精神病学的影响以及其最近决定放弃这一领域工作的影响也受到了仔细审查。论文最后对当代美国精神病学面临的危机进行了评估：过分强调生物学；诊断和治疗方面持续存在的紧迫问题；对未来研究方向的担忧；以及它无法降低困扰精神病患者的过高死亡率。