Recent discoveries in neurobiology have vastly expanded psychiatric knowledge, but there has been a significant lag in the application of these new findings to patient care. Programs of postgraduate education often do not integrate this new scientific information or the attitudes that support it; they seem to favor ideology and theory, psychological or biological. This is reflected in clinical practice as professional advocacy for a particular treatment model, uncritical reliance on expertise, and preference for tradition that limits treatment options for the patient. The dominant obstacle to effective psychiatric treatment may be the mode of financing medical care. Inpatient-based treatment and technical procedures have taken precedence over outpatient and cognitive services, to the detriment of seriously mentally ill patients who require long-term out-patient care. Familial, political, and social forces also tend to subordinate the needs of the patient to those of others. The authors outline strategies to provide excellent and cost-effective psychiatric care for all patients.