As dubious benefits, undesirable effects and high costs dampen the enthusiasm for psychotropic drugs, psychiatrists return to psychotherapy, discovering anew the power of the mind to deal with its own disorders. Altered attitudes can redirect seemingly intractable thought. In the new millennium psychiatrists and psychologists repack old methods in new packages. Rather like meditation, mindfulness training maintains concentration on current experience with the aim of excluding maladaptive neurotic concerns accumulated through life. It rediscovers the essence of ancient philosophical and religious practices. Sadly, it does no better.
Another rediscovery of the wheel, behavioural activation, focuses the mind on constructive responses to events, to “re-engage in life”and bypass resentful ruminations over loss. Its advocates claim that it takes cognitive behaviour therapy to new heights of efficiency and effectiveness. Methods of addressing the psyche even extend to psychosis. Many studies now establish that mania and depression respond better to psychotherapy administered together with suitable medication than either alone. Psychological approaches to schizophrenia make antipsychotic medication unnecessary in about one third of first-episode psychosis in Scandinavia (see Bola JR et al.: Psychosis, 1:4-18, 2009). The discovery that the fit of the child’s genetic temperament to the genetic programming of parental temperament determines the child’s outcome offers hope that psychiatry will devise the best psychodynamic approach to some family problems (Holmes J, Brit. J. Psychiat. 200:439-441, 2012). They give the example of maternal sensitivity (or its absence) to the child’s inborn patterns of behaviour. Prospects of a way out of the current morass returns psychiatry to its core, the psyche.