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From the dawn of the pharmacotherapy era in the 1950s through the 1980s, psychiatry held an integrative interest in the psychology of psychopharmacology. “Set and setting” were shown profoundly to shape psychotropic effects. Research explored how personality and temperament, treatment expectations, setting of administration, and physician characteristics all shaped pharmacotherapy outcomes.
Such interest essentially disappeared from psychiatry in the “Decade of the Brain.” The NIMH, in adopting research domain criteria, essentially ended funding for nonbiomedical research. Concurrently, enthusiasm about neuroscientific discoveries, aggressive direct-to-consumer marketing, and rising pressures from managed care conspired to push psychiatry toward the biomedical reductionist model that dominated psychiatry for two decades.
The massive growth in pharmacotherapy as the first-line response to psychic distress was particularly pronounced among children and adolescents, the majority of whom were prescribed medications in the absence of psychological treatment. Deprived of meaningful opportunities to reflect on the meanings of medication, medicated children invented their own meanings or borrowed them from the environment. Too frequently, these meanings were noxious or even developmentally harmful.
By the first decade of the twenty-first century, psychiatrists were increasingly experiencing the consequences of biomedical reductionism. Thomas Insel recognized that the neurobiological focus had not “moved the needle” in psychiatric recovery. Further, we were seeing a generation of patients for whom psychopharmacology had contributed in subtle and not-so-subtle ways to psychiatric chronification, whether through medicalized identities, experienced powerlessness in the face of “biological” illness, emotional de-skilling from over-reliance on