A historian of psychiatry looking back on the 21st century is most impressed by those unanticipated events that shaped the course of the profession. At the end of the 20th century there was a strong consensus that we were about to unravel the pathophysiology of the major psychiatric disorders that were then endemic—schizophrenia, depression, bipolar disease, obsessive-compulsive disorder, Alzheimer's disease—and that we would develop both new diagnostic methods and useful and effective treatments. However, even as these treatments were being developed it became clear that they would be of little public health importance. Few had imagined this to be possible (even though, in retrospect, one might think that the 20th century experience with infectious diseases such as smallpox or polio might have offered a clue).
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