So immersed are we in both an era of great and at times overwhelming technological and scientific change that we can be easily forgiven if we can’t see clearly what these changes mean for our views of human nature, our understanding of the brain and mental functioning, and our definition of mental illness. If the discovery of the neuron by Ramón y Cajal in 1888 was a major contributor to the rise of neuroscience in the early 20th century and influenced Freud’s pre-psychoanalytic neurobiologic theorizing, how much more will our perspective be upended by the flood of work currently under way? 

At the same time, much doesn’t appear to change. Mental illness affects, as ever, the most human and intimate of our capacities. It impacts our ability to understand the world around and in us and to define our sense of self and can place us in emotional and cognitive confusion. 

Likewise, the discrimination that patients with mental disorders encounter seems to lessen slowly, if at all, especially when we monitor these circumstances day to day. At times our patients and even we are subject to disparagement and harsh criticism. And while these experiences aren’t pleasant, maintaining perspective here as well, is important. We may disagree strongly with those who are skeptical of, or hostile, to the reality of psychiatric illness. Spend even a few days in any emergency room or care for a patient with severe catatonia who, bedridden and requiring feeding support, gets dramatically better with electroconvulsive therapy and the reality and impact of mental illness is quite clear. Spend time in any prison and it is clear that our system has failed to care for those who are ill and instead incarcerates them.  

While it is, in general, wise to avoid applying psychological interpretations to credible intellectual disputes, one is nevertheless left with the nagging sense that the intensity of the critical response to psychiatry may in part be due to the importance of behavior and psychological life to human beings, especially in modern culture. Just as we shouldn’t medicalize the sufferings of everyday life, we also can’t and must not ignore the reality of psychiatric illness. In the heat of engagement or battle, we can be rightly discouraged with the slow pace of change or progress in any of these areas. Stepping back, one can see not just the growing improvement in the care we are providing, but a much more open and honest public discussion of the impact of these illnesses and how far we have to go to achieve true equity. The bravery of those who have confronted the stigma associated with mental illness, regardless of personal risk, and have spoken openly about their lives and experiences is remarkable to witness.