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The study discussed by Mallo, Mintz, and Lewis is best viewed as a critical assessment of an important dimension of organized psychiatry rather than simply as a research report. There is little question that American psychiatry is experiencing an identity crisis. Not so long ago it appeared that psychiatry could crystallize around a coherent model of the mind provided by psychoanalytic psychology. This proved illusory for many reasons which are outside the scope of these (brief) comments. A movement toward psychobiology followed but this sometimes included an overly simplistic component of biological determinism. Some psychiatrists embraced the belief that psychiatry should view itself as applied neuroscience and that issues pertaining to the mind should fall into the purview of non-medical disciplines; primarily psychology. More or less at the same time great emphasis was placed on the notion of evidence-based clinical practice. This was often unaccompanied by deep critical thought about the nature of evidence, however. A perspective more commonly believed than many psychiatrists may fully realize is that major psychological disorders could be adequately treated by the administration of chemical compounds. If the correct medications were prescribed, positive results would inevitably follow.
Regrettably they did not. The authors note that the results of major investigations including the STAR*D, STEP-BD, and PORT studies were disappointing. This sobering result is of course compatible with the complex nature of psychiatric disorders. Most patients with clinically meaningful psychiatric problems suffer from multiple complex physical and behavioral disorders. Vast numbers also live in poverty and either have poor or absent social support or experience chronic