シンポジウム：The Hoped Horizon of Psychiatry

第163回日本精神神経学会総会

シ ⃞ン ⃞ポ ⃞ジ ⃞ウ ⃞ム⃞

Future of Psychiatry: Analysis of Strengths, Weaknesses,Opportunities and Threats
Ali‑Akbar Nejatisafa, M D（Assistant Professor of Psychiatry, Department of Psychiatry,Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran , Iran）

Although very diﬃcult,prediction is necessary for sensible programming for the future ofpsychiatry.

impact events（positive or negative）, should
they occur.
The next 20 years are likely to witness a

Futures studies, foresight, or futurology isrevolution in our understanding of the humanthe science, art and practice of postulating

brain, with implications for virtually every

possible, probable, and preferable futures anddomain of human activity, from mental healththe worldviews and myths that underlie them.

to software design and academic performance

Future studies seek to understand what is likely

and real‑life decision‑making.

to continue, what is likely to change,and what

In the next 20 years we can watch :is novel. Part of the discipline thus seeks asystematic and pattern‑based understanding of
the past and present, and to determine thelikelihood of future events and trends.
It includes analyzing the sources, patterns,and causes of change and stability in the attempt to develop foresight and to map possible‑To map the human brain in much greater
detail.
‑Developments in several technologies andscientiﬁc disciplines: Imaging, Computation,Genetics and genomics‑Better understanding of a number of psychiatric illnesses and their treatment.

futures. The tension between predictabilityand‑With better understanding of the proces-

unpredictability is a source of controversy andses underlying learning, educational programs

conﬂict. Some argue that the future is essen-

tailored to ﬁt diﬀerent learning patterns could

tially unpredictable, and that “the best way to

be developed.

predict the future is to create it.” Others‑Emergence of ʻ‑lifeneurocognoceuticalsʼ

believe,probability,modeling and statistics will

style drugs for enhancing or augmenting

allow us to continue to improve our understand-cognitive function or creating desirable psycho-

ing of probable futures.

logical emotional states.

Future studies are often summarized as

We cannot enter the future until we havebeing concerned with “three Pʼ
s and a W,”orunderstood our past. This article provides apossible, probable, and preferable futures, plus

brief analysis of strengths, weaknesses, oppor-wildcards, which are low probability but hightunities and threats of the psychiatry. The

精神経誌（2010）112 巻 2 号

164

SWOT analysis can be used for the future

psychiatry, psychopharmacology, functional

planning.

neuroimaging and psychiatric genetic provide
scientiﬁc evidence about the nature of mental
Strengths and weaknesses

disorders that were very promising. In regard

M odern psychiatry is approximately 200

with more emphasis on biological psychiatry inyears old. During these two centuries diﬀerent

the last decade some authors became concerned

psychiatric movements were developed : Objec-

about moving from a “brainless psychiatry”oftive‑Descriptive Psychiatry, Psychoanalytic

the past for that of a “
mindless psychiatry”of

Psychiatry, Existential Psychiatry, Social Psy-

the present and future.

chiatry and Biological Psychiatry. Each move-dences criticized the this kind of “
mindlessment had great impacts on psychiatry, andpsychiatry:

The following evi-medicine. The emergence of biopsychosocial

Underwhelming evidence of eﬃcacy ofmodel would appear to be a major step in

medication for example about a third of publi-

moving toward an adequate workable model.

shed studies show no diﬀerence between antide-In regard with this model psychiatry can bepressants and placebo.

considered as the most humanistic discipline ofdiﬀerence in improvement scores is only 1.8

medicine.

Mean drug‑placebo

M edical practice is increasingly

points on the Hamilton Rating Scale for De-

devoted to ameliorating chronic inﬁrmities, apression. Ratersʼexpectations and patientsʼ

task in which psychosocial issues are promi-

suggestibility could entirely explain the small

nent. Changing the biobehavioural risk factors

eﬀect size.

for morbidity and mortality（smoking, eating,

Lack of appreciation of environmental fac-drug taking, drinking and driving）challenges

tors is another shortcoming in this approach.

the competence of all physicians.

PerhapsGenetics of psychiatric disorders so complex

one‑half of physician visits are for complaints

that accurate prediction may not be possible.

without an ascertainable biological basis.

Another problem is lack of abilityto exam-

Without curiosity about life circumstances andine structure and function of the mind directly.

an attempt to alter them,the physicianʼs activi-

Structural and functional cerebral abnormali-ties become futile, medical costs mount, andties are at best subtle rather than gross. Brainpatient dissatisfaction increases. Comprehen-cytoarchitecture itself is fashioned by input

sive evaluation and eﬀective treatment plan-from the social environment

ning require the physician to be as knowledgea-

But the emerging evidence of eﬀectivenessble about the psychosocial determinants ofof psychotherapy from systematic researchhealth as about its molecular base.

provides a foundation to emphasis again on

Some authors, like Dr. S. Nasir Ghaemi,

psychotherapy as an important way of treat-

criticized the biopsychosocial models, and they

ment of mental health problems. All positive

believe psychiatry needs a more comprehensive

futures depend on a vision that is broad enoughmodel. In his famous book, “The Concepts ofto cope with all consideration.

Psychiatry”, Dr. Ghaemi provides a pluralistic
approach to the mind and mental illness.
In recent decades advances in biological

Opportunities and threats
The past centurywitnessed the overwhelm-Powered by TCPDF (www.tcpdf.org)

シンポジウム：The Hoped Horizon of Psychiatry165

ing changes in the world,the more globalization

national collaboration for education, planningwith decreasing cultural diversity and increas-and policy making for mental health in theing disparity between rich and poor, bothworld and increase in knowledge about mental

among and within countries. Increasing de-health issues among general population.

mand for mental health services,aging of population, immigration, regional wars and naturalConclusiondisasters are among the problems of the future.

The situation of psychiatry in the past

Another threat is growing public concern

century especially in recent decades was chan-

about real and perceived conﬂicts of interest

ged prominently. The movement of psychiatricbetween the medical profession and the phar-train continues to the future. But mental healthmaceutical industry.

professionals are not the merely subject toPsychiatrists may have the following op-

future changes; they are also active players

portunities : the more globalization with

with inﬂuence in wider societal context. The

decreasing cultural diversity, the more rapid

challenge is to take a proactive role in creating

access to scientiﬁc information,the more inter-the shape of mental health care in the future.